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Health Status and Clinical Outcomes in Older Adults With Chronic Coronary Disease

Nguyen, Dan D. (author)
St Lukes Mid Amer Heart Inst, 4401 Wornall Rd, Kansas City, MO 64011 USA.;Univ Missouri, Kansas City, MO USA.
Spertus, John A. (author)
St Lukes Mid Amer Heart Inst, 4401 Wornall Rd, Kansas City, MO 64011 USA.;Univ Missouri, Kansas City, MO USA.
Alexander, Karen P. (author)
Duke Cln Res Inst, Durham, NC USA.
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Newman, Jonathan D. (author)
NYU, Grossman Sch Med, New York, NY USA.
Dodson, John A. (author)
NYU, Grossman Sch Med, New York, NY USA.
Jones, Philip G. (author)
St Lukes Mid Amer Heart Inst, 4401 Wornall Rd, Kansas City, MO 64011 USA.;Univ Missouri, Kansas City, MO USA.
Stevens, Susanna R. (author)
Duke Cln Res Inst, Durham, NC USA.
O'Brien, Sean M. (author)
Duke Cln Res Inst, Durham, NC USA.
Gamma, Reto (author)
Univ Hosp Inselspital, Swiss Cardiovasc Ctr, Dept Cardiol, Bern, Switzerland.
Perna, Gian P. (author)
Ospedali Riuniti Ancona, Dept Cardiol, Ancona, Italy.
Garg, Pallav (author)
London Hlth Sci Ctr, London, ON, Canada.
Vitola, Joao V. (author)
Quanta Diagnost, Curitiba, Brazil.
Chow, Benjamin J. W. (author)
Univ Ottawa, Heart Inst, Ottawa, ON, Canada.
Vertes, Andras (author)
Del Pest Centrumkohaz Hosp, Natl Inst Hematol & Infect Dis, Cardiovasc Dept, Budapest, Hungary.
White, Harvey D. (author)
Auckland City Hosp, Green Lane Cardiovasc Serv, Auckland, New Zealand.;Univ Auckland, Auckland, New Zealand.
Smanio, Paola E. P. (author)
Inst Dante Pazzanese Cardiol & Fleury Med & Saude, Sao Paulo, Brazil.
Senior, Roxy (author)
Northwick Pk Hosp & Clin Res Ctr, Royal Brompton Hosp, Dept Med, London, England.
Held, Claes, 1956- (author)
Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)
Li, Jianghao (author)
Duke Cln Res Inst, Durham, NC USA.
Boden, William E. (author)
Vet Affairs, New England Healthcare Syst, Boston, MA USA.
Mark, Daniel B. (author)
Duke Cln Res Inst, Durham, NC USA.
Reynolds, Harmony R. (author)
NYU, Grossman Sch Med, New York, NY USA.
Bangalore, Sripal (author)
NYU, Grossman Sch Med, New York, NY USA.
Chan, Paul S. (author)
St Lukes Mid Amer Heart Inst, 4401 Wornall Rd, Kansas City, MO 64011 USA.;Univ Missouri, Kansas City, MO USA.
Stone, Gregg W. (author)
Icahn Sch Med Mt Sinai, Zena & Michael A Wiener Cardiovasc Inst, New York, NY USA.;Cardiovasc Res Fdn, New York, NY USA.
Arnold, Suzanne V. (author)
St Lukes Mid Amer Heart Inst, 4401 Wornall Rd, Kansas City, MO 64011 USA.;Univ Missouri, Kansas City, MO USA.
Maron, David J. (author)
Stanford Univ, Dept Med, Palo Alto, CA USA.
Hochman, Judith S. (author)
NYU, Grossman Sch Med, New York, NY USA.
Grp, ISCHEMIA Res (author)
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St Lukes Mid Amer Heart Inst, 4401 Wornall Rd, Kansas City, MO 64011 USA;Univ Missouri, Kansas City, MO USA. Duke Cln Res Inst, Durham, NC USA. (creator_code:org_t)
Elsevier BV, 2023
2023
English.
In: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097 .- 1558-3597. ; 81:17, s. 1697-1709
Related links:
https://urn.kb.se/re...
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https://doi.org/10.1...
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  • Journal article (peer-reviewed)
Abstract Subject headings
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  • BACKGROUND: Whether initial invasive management in older vs younger adults with chronic coronary disease and moderate or severe ischemia improves health status or clinical outcomes is unknown. OBJECTIVES The goal of this study was to examine the impact of age on health status and clinical outcomes with invasive vs conservative management in the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial.METHODS: One-year angina-specific health status was assessed with the 7-item Seattle Angina Questionnaire (SAQ) (score range 0-100; higher scores indicate better health status). Cox proportional hazards models estimated the treatment effect of invasive vs conservative management as a function of age on the composite clinical outcome of cardiovascular death, myocardial infarction, or hospitalization for resuscitated cardiac arrest, unstable angina, or heart failure.RESULTS: Among 4,617 participants, 2,239 (48.5%) were aged <65 years, 1,713 (37.1%) were aged 65 to 74 years, and 665 (14.4%) were aged $75 years. Baseline SAQ summary scores were lower in participants aged <65 years. Fully adjusted differences in 1-year SAQ summary scores (invasive minus conservative) were 4.90 (95% CI: 3.56-6.24) at age 55 years, 3.48 (95% CI: 2.40-4.57) at age 65 years, and 2.13 (95% CI: 0.75-3.51) at age 75 years (Pinteraction = 0.008). Improvement in SAQ Angina Frequency was less dependent on age (Pinteraction = 0.08). There were no age differences between invasive vs conservative management on the composite clinical outcome (Pinteraction = 0.29).CONCLUSIONS: Older patients with chronic coronary disease and moderate or severe ischemia had consistent improvement in angina frequency but less improvement in angina-related health status with invasive management compared with younger patients. Invasive management was not associated with improved clinical outcomes in older or younger patients.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Keyword

coronary artery disease
older adults
quality of life

Publication and Content Type

ref (subject category)
art (subject category)

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