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Frailty and acute coronary syndrome: does gender matter?

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Journal of Geriatric Cardiology 2019年第2期16卷 138-144页

作者： Lourdes Vicent Manuel martinez-Selles Servicio de Cardiologia Hospital General Universitario Gregorio MaraiionCIBERCVMadridSpain Universidad Europea Universidad ComplutenseMadridSpain

There are important sex-related differences in elderly patients with acute coronary syndrome(ACS).Women are older,more frequently frail,and present more comorbidities than men.Atypical symptoms at presentation are also more common in female patients,they are leaded to a delayed diagnosis and treatment.Coronary angiography and subsequent revascularization are frequently underused in elderly women and they tend to receive less guidelines-recommended therapies.The prognosis in elderly frail women with ACS is poor,and it is with high mortality and readmissions rates.Bleeding is recurrent ischemic events in which it is more frequent in women than in men.Recovery time might be long,and a multidisciplinary approach is desirable to improve prognosis and quality of life.Further studies are needed in order to clarify the benefit of the different therapies in the group of frail women,and this is particularly true for revascularization,as scientific evidence in this group is very scarce.

关键词： Acute coronary syndrome Frailty The elderly Women

Atrial fibrillation in the elderly

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Journal of Geriatric Cardiology 2017年第3期14卷 155-157页

作者： Manuel martinez-Selles Antonio Bayes de Lun Hospital General Universitario Gregorio Maranon CIBER C V Universidad Europea Universidad Complutense Madrid Spain Fundacio Investigacio Cardiovascular ICCC Hospital de Sant Pau Barcelona Spain

Atrial fibrillation (AF) is the most frequent arrhythmia. Due to population aging, AF is a growing epidemic and its importance will continue to increase in the next decades. Although the prevalence of AF is high in advanced age, the number of subjects with predisposing factors for AF is even higher. Most of these factors increase the risk of atrial fibro- sis, an important component of atrial arrhythmia mecha- nisms. In fact, the new techniques to detect atrial fibrosis are showing the strong association between atrial fibrosis and AF risk. Regarding predisposing factors for AF, interatrial block (LAB) seems to be a key factor.

关键词：老年人心房颤动心律失常诱发因素人口老龄化纤维化组成部分

Prediction of sudden death in elderly patients with heart failure

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Journal of Geriatric Cardiology 2018年第2期15卷 185-192页

作者： Ana Ayesta Helena martinez-sellest Antonio Bayes de Luna Manuel martinez-Selles Cardiology Department Hospital Universitario del Sureste Arganda del Rey Madrid Spain Universidad Complutense Madrid Spain Fundacio lnvestigacio Cardiovascular ICCC Hospital de Sant Pau Barcelona Spain Cardiology Department Hospital General Universitario Gregorio Maranon CIVERCK Universidad Europea Madrid Spain

最，心失败(HF ) 联系了死亡由于突然的心脏的死亡(SCD ) 和变得更坏的 HF，特别地在减少的喷射的情况中部分。预言并且阻止 SCD 是一个重要目标，但是最工作不包括或有先进年龄的很少病人，和在有 HF 的老病人的 SCD 的预防仍然是争论... 详细信息

最，心失败(HF ) 联系了死亡由于突然的心脏的死亡(SCD ) 和变得更坏的 HF，特别地在减少的喷射的情况中部分。预言并且阻止 SCD 是一个重要目标，但是最工作不包括或有先进年龄的很少病人，和在有 HF 的老病人的 SCD 的预防仍然是争论的。处于 SCD 的年度率的最近的减小最近被描述了，但是如果这在先进年龄病人也是真的，它不是清楚的。尽管医生们经常有有 HF 的老病人主要死于泵失败的感觉，年龄与 SCD 被联系，低估 SCD 的重要性。被联系了到 SCD 的另外的临床的变量是症状，纽约心协会功能的类， ischemic 原因，和 comorbidities (长期的妨碍的肺的疾病，肾的机能障碍和糖尿病) 。应该也被考虑的一些测试结果被让喷射室部分和直径， natriuretic 肽，非支撑的室的心悸亢进和自治畸形。所有这些标记的联合可能是最好的选择预言 SCD。不同风险分数被描述了并且尽管为老人口没有特定的，当一个风险预言者和一些与吝啬的年龄在人口被开发，最包括年龄 > 65 年。最后，强调这些分数应该能预言 SCD 的任何类型作为是重要的尽管大多数由于 tachyarrhythmias， bradyarrhythmias 也起一个作用，特别地在情况中老。

关键词：预言死亡 SCD 机能障碍年龄 HF 糖尿病部分和

Anticoagulation in elderly patients at high risk of atrial fibrillation without documented arrhythmias

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Journal of Geriatric Cardiology 2017年第3期14卷 166-168页

作者： Manuel martinez-Selles Eusebio Garcia-Izquierdo Jaen Ignacio Fernandez Lozano Servicio de Cardiologia Hospital General Universitario Gregorio Maranon Universidad Complutense CIBERCV Madrid Spain Servieio de Cardiologia Hospital Universitario Puerta de Hierro Majadahonda Madrid Spain

Recent studies have suggested that patients with high CHA2DS2VASc-score [Congestive Heart failure, hyperten- sion, Age≥75 years (doubled), Diabetes, Stroke (doubled), Vascular disease, Age 65-74 years, Sex category (female sex)] thromboembolic complications occurred irrespective of the presence of atrial fibrillation (AF) and anticoagulant therapy may be initiated irrespective of documented AF.

关键词：治疗心律失常抗凝房颤充血性心力衰竭患者老年血管疾病

Applicability of the PRECISE-DAPT score in elderly patients with myocardial infarction

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Journal of Geriatric Cardiology 2018年第12期15卷 713-717页

作者： Albert Ariza-Sole Francesc Formiga Manuel martinez-Selles Maria T Vidan Jaime Aboal department of Cardiology Hospital Universitari de BellvitgeL'Hospitalet de LlobregatBarcelona Geriatrics Medicine Unit Internal Medicine Department.Hospital Universitari de BellvitgeL'Hospitalet de LlobregatBarcelona Department of Cardiology Hospital General Universitario Gregorio MaranonMadrid Geriatrics Medicine Department Hospital General Universitario Gregorio MarahonMadrid Department of Cardiology Hospital Universitari Josep TruetaGirona

Background Elderly patients with acute coronary syndromes(ACS)are at higher risk both for ischemic and bleeding complications.Current guidelines recommend the PRECISE-DAPT score for bleeding risk stratification in this setting,but no study assessed its applicability in elderly patients.This study aimed to assess the performance of the PRECISE-DAPT score in a series of non-selected elderly patients with ACS from routine clinical practice.Methods The IFFANIAM registry included prospectively patients aged>75 years with ST segment elevation myocardial infarction(STEMI).Main outcome measured was the incidence of relevant bleeding after discharge(bleeding leading to hospital readmission,need for transfusion,intervention,stop of antithrombotic drugs or death).Bleeding risk was classified:(A)according to PRECISE-DAPT values above or not the recommended cut-off point(>25);and(B)according to the quartiles of PRECISE-DAPT values observed in the IFFANIAM series(QI:45).Results A total of 208 patients were included.Mean age was 81.9±4.5 years.Most patients(92.6%)had a PRECISE-DAPT value>25.A total of 25 patients(12.0%)had bleeding events and 49 patients(23.6%)died.No significant differences regarding the incidence of bleeding were observed according to the recommended cutt of point>25.However,a progressive increase in the incidence of bleeding was observed across PRECISE-DAPT quartiles observed in this series(P=0.038).Conclusions The vast majority of elderly patients have PRECISE-DAPT values above the recommended cut-off point for bleeding risk.Using different cut-off points could be a more rational approach for predicting bleeding risk in these complex patients.

关键词： Acute coronary syndromes Bleeding Prognosis The elderly

Hospital without dyspnea： rationale and design of a multidisciplinary intervention

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Journal of Geriatric Cardiology 2016年第7期13卷 625-631页

作者： Lourdes Vicent Juan manuel Nunez Olarte Luis Puente-Maestu Esther Artajona Francisco Fernandez-Aviles Manuel martinez-Selles Department of Cardiology Gregorio Maranon General Hospital Madrid Spain Department of Palliative Care Gregorio Maranon General Hospital Madrid Spain Department of Respirology Gregorio Maranon General Hospital Madrid Spain European University of Madrid Madrid Spain Complutense University of Madrid Madrid Spain

呼吸困难是普通、停用的症状呼吸并且心疾病，它在发生正在成长。在医院承认期间，呼吸急促下面诊断、下面对待，尽管有为控制症状可得到的治疗。我们开发了指导到医药职员在处理呼吸困难支持这些药理学和非药理学工具的应用程序的定制... 详细信息

呼吸困难是普通、停用的症状呼吸并且心疾病，它在发生正在成长。在医院承认期间，呼吸急促下面诊断、下面对待，尽管有为控制症状可得到的治疗。我们开发了指导到医药职员在处理呼吸困难支持这些药理学和非药理学工具的应用程序的定制的实现策略。主要目的是不收到呼吸困难的足够的消除的病人的率到减少。这是四阶段的伪试验性的研究。干预在将在心病学和呼吸的药部门被教的二次教学谈话在于。内容将被辩解的照顾专家准备，基于为呼吸困难和病人需要的管理的可得到的工具。在就医的病人的呼吸困难的代表性的研究将在干预前后被执行在诊所由于变化在呼吸困难紧张查明改进。最后阶段为根据我们的经验基于的呼吸困难管理在一致协议的创造在于。这研究的结果被期望价值大并且在不久的将来可以改变临床的实践并且支持一变化为呼吸困难照顾更好。

关键词：长期的肺的疾病呼吸困难心失败辩解的照顾

Diagnosis of interatrial block

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Journal of Geriatric Cardiology 2017年第3期14卷 161-165页

作者： Antoni Bay, s de Luna Adrian Baranchuk Luis Alberto Escobar Robledo Albert Masso van Roessel Manuel martinez-Selles Catalan Institute of Cardiovascular Sciences St. Pau Hospital Barcelona Spain Heart Rhythm Service Kingston General Hospital Queen's University Kingston ON Canada Cardiology Department Hospital Universitario Gregorio Maranon Universidad Europea Universidad Complutense Madrid Spain

In the 70's, we classified for the first time the blocks at the atrial level into interatrial blocks (IAB), partial and advanced, and other types of atrial blocks including the concept of atrial aberrancy, and atrial ... 详细信息

关键词：房间诊断心房

End-of-life care in a cardiology department： have we improved？

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Journal of Geriatric Cardiology 2016年第7期13卷 587-592页

作者： Juan Rulz-Garcia Pablo Dlez-Villanueva Ana Ayesta Vanessa Brufia Lourdes M Figueiras-Graillet Laura Gallego-Parra Francisco Fernandez-Aviles Manuel martinez-Selles Department of Cardiology Hospital General Universitario Gregorio Maranon Calle Doctor Esquerdo Madrid Spain Department of Cardiology Hospital Universitario de Torrejon Calle Mateo Inurria Torrejon de Ardoz Madrid Spain Universidad Francisco de Vitoria Carretera Pozuelo a Majadahonda Pozuelo de Alareon Madrid Spain Department of Cardiology Hospital Universitario de la Princesa Calle de Diego de Leon Madrid Spain Departmet of Cardiology Hospital Universitario del Sureste Ronda del Sur Arganda del Rey Madrid Spain Universidad Complutense de Madrid Av. Seneca Madrid Spain Universidad Europea de Madrid Urbanizacion E1Bosque Calle Tajo Villaviciosa de Odon Madrid Spain

BackgroundEnd-of-life 照顾不通常是在心病学部门的优先级。我们寻求了在 do-not-resuscitate (DNR ) 的介绍以后在 end-of-life 照顾评估变化顺序 protocol.Methods &；在在二经期的一个心病学部门的所有死亡的 ResultsRetrosp... 详细信息

BackgroundEnd-of-life 照顾不通常是在心病学部门的优先级。我们寻求了在 do-not-resuscitate (DNR ) 的介绍以后在 end-of-life 照顾评估变化顺序 protocol.Methods &；在在二经期的一个心病学部门的所有死亡的 ResultsRetrospective 分析，在协议的介绍前后。人口统计的特征， DNR 订单的使用，和 end-of-life 照顾的比较在两个时期之间发出，根据在表(组 A ) ，一份常规 DNR 订单(组 B ) 或任何 DNR 的缺席订的新 DNR 的第二经期(组 C ) 的存在。死亡的数字在两个时期是类似的(n = 198 对 n = 197 ) 。与一份 DNR 订单死的病人的率显著地增加了(57.1% 对 68.5% ；P = 0.02 ) 。仅仅在两个时期的 4% 病人知道关于心肺的复活作的决定。在组 A 的病人更早收到了 DNR 顺序一天，并且 24.5% 在录取的开始的 24 h 以内收到了它(对 2.6% 在第一个时期；P <；0.001 ) 。在有一个可植入的 cardioverter 使用高压脉冲来消减心脏(ICD ) 的组 A 的所有病人把电震疗法撤销(对 25.0% 在第一个时期；P = 0.02 ) 一个 DNR 顺序协议的 .ConclusionsThe 介绍可以由增加使用并且弄短在心脏病患者改进 end-of-life 照顾 DNR 订单的登记的时间。它可以也在地方与这些订单在病人贡献增加 ICD 释放。然而，在疾病的迟了的阶段的表的介绍没能改进耐心的参予。

关键词：心脏病患者护理生命 DNR 死亡人数统计特征心肺复苏 ICD

Clinical and prognostic implications of delirium in elderly patients with non–ST-segment elevation acute coronary syndromes

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Journal of Geriatric Cardiology 2019年第2期16卷 121-128页

作者： Miquel Vives-Borras Manuel martinez-Selles Albert Ariza-Sole Maria T.Vidan Francesc Formiga Hector Bueno Juan Sanchis Oriol Alegre Albert Duran-Cambra Ramon Lopez-Palop Emad Abu-Assi Alessandro Sionis LONGEVO-SCA Investigators Department of Cardiology Hospital de la Santa Creu i Sant PauInstitute of Biomedical Research I1B Sant PauCIBERCVUniversitat Autonoma de BarcelonaBarcelonaSpain department of Cardiology Hospital General Universitario Gregorio MarahonC1BERCVUniversidad ComplutenseUniversidad EuropeaMadridSpain Hospital Universitari de Bellvitge L'Hospitalet de LlobregatBarcelonaSpain Hospital General Universitario Gregorio Maranon IiSGMCIBERFESUniversidad ComplutenseMadrid.Spain Hospital Doce de Octubre Centro Nacional de Investigaciones CardiovascularesMadridSpain Hospital Clinico de Valencia INCLIVAUniversidad de ValenciaCIBERCVSpain Hospital Universitario San Juan AlicanteSpain Hospital Alvaro Cunqueiro VigoSpain 不详

Background Elderly patients with non-ST-segment elevation acute coronary syndromes(NSTE-ACS)may present delirium but its clinical relevance is unknown.This study aimed at detennining the clinical associated factors,and prognostic implications of delirium in old-aged patients admitted for NSTE-ACS.Methods LONGEVO-SCA is a prospective multicenter registry including unselected patients with NSTE-ACS aged>80 years.Clinical variables and a complete geriatric evaluation were assessed during hospitalization.The association between delirium and 6-month mortality was assessed by a Cox regression model weighted for a propensity score including the potential confounding variables.We also analysed its association with 6-month bleeding and cognitive or functional decline.Results Among 527 patients included,thirty-seven(7%)patients presented delirium during the hospitalization.Delirium was more frequent in patients with dementia or depression and in those from nursing homes(27.0%vs.3.1%,24.3%vs.11.6%,and 11.1%V5.2.2%,respectively;all P<0.05).Delirium was significantly associated with in-hospital infections(27.0%vs.5.3%,P<0.001)and usage of diuretics(70.3%vs.49.8%,P=0.02).Patients with delirium had longer hospitalizations[median 8.5(5.5-14)vs.6.0(4.0-10)days,P=0.02]and higher incidence of 6-month bleeding and mortality(32.3%vs.10.0%and 24.3%vs.10.8%,respectively;both P<0.05)but similar cognitive or functional decline.Delirium was independently associated with 6-month mortality(HR=1.47,95%CI:1.02-2.13,P=0.04)and 6-month bleeding events(OR=2.87;95%CI:1.98-4」6,P<0.01).Conclusions In-hospital delirium in elderly patients with NSTE-ACS is associated with some preventable risk factors and it is an independent predictor of 6-month mortality.

关键词： Acute coronary syndromes Delirium Prognosis The elderly