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Elderly patients with acute coronary syndromes admitted to Italian intensive cardiac care units: a Blitz-3 Registry sub-analysis

Casella, Gianni; Scorcu, Giampaolo; Cassin, Matteo; Chiarella, Francesco; Chinaglia, Alessandra; Conte, Maria R.; Fradella, Giuseppe; Lucci, Donata; Maggioni, Aldo P.; Visconti, Luigi O.on behalf of the Blitz-3 Investigators

Journal of Cardiovascular Medicine: March 2012 - Volume 13 - Issue 3 - p 165–174
doi: 10.2459/JCM.0b013e3283515be3
Original articles: Epidemiology and prevention
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Background Guideline-recommended therapies for acute coronary syndromes (ACS) derive from randomized trials in which elderly patients are underrepresented. Although numbers of this population are increasing, they are largely undertreated in the real world.

Objective The study evaluates the impact of older age on care for patients with ACS admitted to the Italian Intensive Cardiac Care Units (ICCUs) network.

Methods We analyzed data from the BLITZ-3 Registry in order to assess in-hospital care among unselected elderly patients (≥75 years).

Results From 7–20 April 2008, 6986 consecutive patients with acute cardiac conditions were admitted to ICCUs and prospectively enrolled; 3636 (52%) had ACS and 38% of them were elderly. Elderly patients had a higher risk profile, their median length of stay in ICCU was longer [4 days, interquartile range (IQR): 3–6 vs. 3 days, IQR: 2–5; P < 0.0001] and guideline-recommended care was applied less often. At multivariable analysis, elderly patients were less likely to receive reperfusion [odds ratio (OR) = 0.53, 95% confidence interval (CI) = 0.42–0.67] for ST-elevation, or early coronary angiography (OR = 0.45, 95% CI = 0.37–0.56) for non-ST elevation ACS. Besides, unadjusted in-ICCU total mortality was higher for elderly patients with ST-elevation (11.8% elderly vs. 1.8% younger patients; P < 0.0001) or non-ST-elevation (3.9% elderly vs. 0.6% younger patients; P < 0.0001) ACS.

Conclusion In a nationwide survey, age impacts on care. The elderly with ACS have a higher risk profile but receive less guideline-recommended care than younger patients. Thus, further improvements in care of this population should be pursued.

aCardiology Department, Maggiore Hospital, Bologna

bCardiology Department, G. Brotzu-S. Michele Hospital, Cagliari

cCardiology Department, Santa Maria degli Angeli Hospital, Pordenone

dCardiology Department, Santa Corona Hospital, Pietra Ligure

eCardiology Department, Maria Vittoria Hospital

fCardiology Department, Mauriziano Hospital, Torino

gCardiology Department 1, Careggi Hospital

hANMCO Research Center, Firenze

iCardiology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

*See acknowledgement section for a complete list of participating centers and investigators.

Correspondence to Gianni Casella, MD, BLITZ-3 Coordinating Center, ANMCO Research Center, Via La Marmora 34 – 50121 Firenze, ItalyTel: +39 055 5101361; fax: +39 055 5101320; e-mail: centrostudi@anmco.it

Received 21 July, 2011

Revised 2 September, 2011

Accepted 30 November, 2011

© 2012 Italian Federation of Cardiology. All rights reserved.