SP - Cardio (Cardiovascular)

Introduction: Evidence of the optimal blood pressure target for older people with disability in long-term care is limited. We aim to estimate the associations of blood pressure with all-cause and cause-specific mortality in older people with different profiles of disability.

Methods: This prospective cohort study was based on the government-led long-term care program in Chengdu, China, including 41,004 consecutive disabled adults aged ≥ 60 years. The association between blood pressure and mortality was analyzed with doubly robust estimation, which combined exposure model by inverse probability weighting and outcome model fitted with Cox regression. The non-linearity was examined by restricted cubic spline. The primary endpoint was all-cause mortality, and the secondary endpoints were cardiovascular and non-cardiovascular mortality.

Results: The associations between systolic blood pressure (SBP) and all-cause mortality were close to a U-shaped curve in mild-moderate disability group (Barthel index ≥ 40), and a reversed J-shaped in severe disability group (Barthel index < 40). In mild-moderate disability group, SBP < 135 mmHg was associated with elevated all-cause mortality risks (HR 1.21, 95% CI, 1.10-1.33), compared to SBP between 135-150 mmHg. In severe disability group, SBP <150 mmHg increased all-cause mortality risks (HR 1.21, 95% CI, 1.16-1.27), compared to SBP between 150-170 mmHg. The associations were robust in subgroup analyses in terms of age, cardiovascular comorbidity and antihypertensive treatment. Diastolic blood pressure (DBP) < 67 mmHg (HR 1.29, 95% CI, 1.18-1.42) in mild-moderate disability group and < 79 mmHg (HR 1.15, 95% CI, 1.11-1.20) in severe disability group both demonstrated an increased all-cause mortality risk.

Conclusion: The optimal blood pressure range was higher in older long-term care people with severe disability than those with mild-moderate disability. This study provides new evidence for optimal individualized management of blood pressure in disabled older people in long-term care settings.

Introduction: 

There is limited data on the prevalence of hypertriglyceridemia (HTG), a recognized risk factor for cardiovascular disease, in the northeastern region of Colombia. Therefore, we aimed to characterize the local prevalence of HTG and cardiovascular disease-related variables in the subsidized regime population of a city in northeastern Colombia during the period 2020-2022.

Materials and Methods: 

We conducted a retrospective review of medical records from all health centers in Bucaramanga, Santander, Colombia. The study included patients aged 60-95 years who were part of the subsidized regime and had records of cardiovascular risk variables, including the lipid profile. Mean ± standard deviation (SD) was used to describe quantitative variables. Microsoft Excel was employed for database creation, and statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS, v.22.1; Chicago, IL).

Results: 

We included 105,461 patients, of whom 72,556 (69%) were female. The mean age was 66 years. The most common comorbidities were hypertension (82%), followed by non-insulin-requiring diabetes mellitus (28%), chronic kidney disease (24%), hypercholesterolemia (24%), insulin-requiring diabetes mellitus (8%), and COPD (8%). A total of 58,456 (55%) patients had hypertriglyceridemia, with mean triglyceride levels of 194.9 mg/dL. Mean cholesterol levels were 168.4 mg/dL, mean HDL levels were 42.7 mg/dL and mean LDL levels were 111.9 mg/dL.

Conclusions: 

More than half of the population enrolled in the subsidized healthcare regime in Bucaramanga, Santander, Colombia, was found to have hypertriglyceridemia during the period 2020-2022, along with other variables related to cardiovascular disease. This finding aligns with reports from other regions of the country.

Introduction:

It is expected that by the fourth decade of the 21st century, chronic obstructive pulmonary disease (COPD) will become the third leading cause of death worldwide. These data require awareness among treating physicians of these patients. 

Material and Methods:

A pilot study was conducted from January 2020 - December 2022 in a South American health institution in which cardiovascular risk was estimated using GLOBORISK and ATP-III criteria. Data derived from the metabolic profile included in the ATP-III criteria were collected. Quantitative variables are presented as mean ± standard deviation or median (interquartile range) according to their distribution and qualitative variables as percentages. Student's t-test was performed to evaluate differences between two variables. All statistical analyses were performed with (SPSS for Windows, v.22.1; Chicago, IL).

Results:

The present study showed that metabolic syndrome variables in these patients were elevated. Male sex was 77% and female 23%, smoking 61%. The GLOBORISK equation found mostly patients with low to moderate cardiovascular risk. It was found that there was a higher cardiovascular risk in those patients with FEV1 less than 30%, showing a statistical correlation of this alteration for the GLOBORISK scale.

Conclusions:

This is the first pilot study that estimates cardiovascular risk using GLOBORISK in the COPD population. We consider integrating national and international networks to compare the results found here.
 

Introduction:

Metabolic syndrome has been associated with an increased risk of cancer. This study evaluated this association in a South American cohort.

Methods:

Retrospective observational study in 100 patients older than 60 years with metabolic syndrome for more than 10 years from a hospital outpatient center. Anthropometric (waist circumference, body mass index), biochemical (triglycerides, HDL cholesterol, fasting glucose) and clinical (arterial hypertension, type 2 diabetes mellitus) parameters were evaluated. The association between metabolic syndrome, its components and cancer risk was analyzed using proportional hazards and chi-square models.

Results:

A statistically significant association was found between abdominal obesity (average waist circumference of 103.8 cm and BMI of 36.05), hypertension and hyperglycemia with an increased risk of cancer. The highest prevalence of cancer occurs in people over 60 years of age. In this group, 72.1% of the cases of the disease are diagnosed in men and 65.8% in women. A higher risk is reported in patients with grade I obesity (BMI 30-34 kg/m2.

Conclusion:

MS is strongly associated with increased cancer risk in older South American adults, especially due to central obesity, hypertension and hyperglycemia.

Introduction:

The sign of Frank or sign of the cleft lobe has been associated with the existence of a disorganization of the elastic fibers and a thickening of the arterioles that causes a vascular sclerosis and a chronic local ischemia of the lobe of the ear.

Objectives:

To determine the relationship of the split lobe sign with cardiovascular diseases in geriatrics patients of the Internal Medicine service of a Southamerican hospital 2017 to July-2018.

Methodology:

A descriptive and cross-sectional observational study of cases and controls to establish a relationship between the sign of the diseased lobe and cardiovascular disease.

Results:

We observed Smoking is a risk factor directly associated with the presence of the cleft lobe sign p (0.047), there being a greater tendency to appear when the intensity of smoking is higher. The presence of the lobe sign generates a relative risk of 2.062 times in terms of cardiovascular events compared to those who do not. Conclusions: We consider that the association found between the sign of the cleft lobe, smoking and cardiovascular diseases, give us an easily identifiable tool for a population at higher risk for the development of these pathologies.

Introduction:

Co-morbidities and frailty are common in older heart failure patients. The aim of this study is to explore the relationship between co-morbidity, frailty and ejection fraction (EF) in older heart failure inpatients.

Methods:

A cross-sectional, observational, retrospective analysis of consecutive patients aged 60 years and over who were admitted with heart failure in a UK hospital. Patients with incomplete data were excluded. Carlson’s comorbidity index (CCI) was used to compute comorbidity, and the Rockwood Clinical Frailty Scale (CFS) was used to measure frailty. The EF was calculated as the midpoint of the ranges measured by echocardiography. IBM SPSS 28 software was used for statistical analysis. Descriptive statistics were used to measure baseline characteristics, and Pearson’s correlation coefficient and linear regression were used to calculate the correlation.

Results and discussion:

101 patients were analysed; 48 males and 53 females. The mean age was 81.2 years (SD 9.98). The mean CCI was 6.97 (SD 1.63), and the mean CFS was 5.09 (SD 1.14).

There was a statistically significant positive correlation between CCI and CFS (r= 0.232; p= .01).

There was a statistically significant inverse correlation between CCI and EF (r= -.277; p=. 005).

When taking into account the level of frailty, the correlation between CCI and EF was much stronger in non-frail than in frail patients (r= -.612; p=. 035 and r= -.216; p= .047, respectively).

There was no correlation between CFS and EF (r= .095; p=.26).

Conclusion:

There was a positive correlation between multi-morbidity and frailty in older inpatients admitted with heart failure. There was a statistically significant inverse correlation between CCI and ejection fraction, but there was no correlation between frailty and ejection fraction.

Introduction

Demographic evaluation of urgent community response teams [UCR] is important to ensure equity of access and clinical outcomes for patients from all socio-demographic groups using such services. This retrospective descriptive study aimed to evaluate demographic and mortality differences between patients referred to UCR in terms of those managed in the community [Group1] versus those subsequently hospitalised [Group2].

Methods

Data was obtained over a 12-month period [2021-2022] for all new patients referred to a 7-day consultant-led UCR that serves a multi-ethnic, inner-city population. Data included demographic details, source of referral, urgency of referral and mortality within 60 days.

Results

Of 995 patients, 75.6%[n=752] were in Group 1; 24.4%[243] were in Group 2. The two groups were comparable in terms of age [mean(SD): 80.1(12.6) vs 80.0(11.4), p=ns] and gender [males:39.4% vs 42.4%,p=ns]. There were similar proportion of Black and minority ethnic patients within the two groups [21.0% (158) vs 24.7% (60), p=ns]. Source of referral were comparable between the two groups[p=ns]; overall, 67.7%[674] were from GP practices, 5.6%[56] Community Practitioners, 4.7%[47] NHS111, 2.7%[27] Ambulance, 32%[32] Palliative care, 5.9%[59] Emergency department, 10.1%[100] post-hospitalisation. Compared to Group 1 [46.9% (353)], significantly more patients in Group 2 were referred for urgent assessment within 2 hours [65.4% (159), p<.001]. more patients died in group2 within 60 days [22.2% (54) vs 11.3% (85), p<0.001].

Discussion

This large survey has described age, gender and ethnic similarities between the two groups, demonstrating equity of provision irrespective protected characteristics. as might be clinically expected, referred for hospitalisation were assessed urgently had higher mortality rates compared to those managed community. study provides valuable information clinicians researchers similar ucr services future.