Universität zu Köln

Pilotto, Alberto, Gallina, Pietro, Panza, Francesco ORCID: 0000-0002-7220-0656, Copetti, Massimiliano, Cella, Alberto, Cruz-Jentoft, Alfonso, Daragjati, Julia, Ferrucci, Luigi, Maggi, Stefania, Mattace-Raso, Francesco, Paccalin, Marc, Polidori, Maria Cristina, Topinkova, Eva ORCID: 0000-0002-6786-4116, Trifiro, Gianluca, Welmer, Anna-Karin ORCID: 0000-0001-5819-8724, Strandberg, Timo and Marchionni, Niccolo ORCID: 0000-0002-8101-4695 (2016). Relation of Statin Use and Mortality in Community-Dwelling Frail Older Patients With Coronary Artery Disease. Am. J. Cardiol., 118 (11). S. 1624 - 1631. BRIDGEWATER: EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC. ISSN 1879-1913

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Abstract

Clinical decision-making for statin treatment in older patients with coronary artery disease (CAD) is under debate, particularly in community-dwelling frail patients at high risk of death. In this retrospective observational study on 2,597 community-dwelling patients aged >= 65 years with a previous hospitalization for CAD, we estimated mortality risk assessed with the Multidimensional Prognostic Index (MPI), based on the Standardized Multidimensional Assessment Schedule for Adults and Aged Persons (SVaMA), used to determine accessibility to homecare services/nursing home admission in 2005 to 2013 in the Padua Health District, Veneto, Italy. Participants were categorized as having mild (MPI-SVaMA-1), moderate (MPI-SVaMA-2), and high (MPI-SVaMA-3) baseline mortality risk, and propensity score-adjusted hazard ratios (HRs) of 3-year mortality rate were calculated according to statin treatment in these subgroups. Greater MPI-SVaMA scores were associated with lower rates of statin treatment and higher 3-year mortality rate (MPI-SVaMA-1 = 23.4%; MPI-SVaMA-2 = 39.1%; MPI-SVaMA-3 = 76.2%). After adjusting for propensity score quintiles, statin treatment was associated with lower 3-year mortality risk irrespective of MPI-SVaMA group (HRs [95% confidence intervals] 0.45 [0.37 to 0.55], 0.44 [0.36 to 0.53], and 0.28 [0.21 to 0.39] in MPI-SVaMA-1,-2, and-3 groups, respectively [interaction test p = 0.202]). Subgroup analyses showed that statin treatment was also beneficial irrespective of age (HRs [95% confidence intervals] 0.38 [0.27 to 0.53], 0.45 [0.38 to 0.54], and 0.44 [0.37 to 0.54] in 65 to 74, 75 to 84, and Z85 year age groups, respectively [interaction test p = 0.597]). In conclusion, in community-dwelling frail older patients with CAD, statin treatment was significantly associated with reduced 3-year mortality rate irrespective of age and multidimensional impairment, although the frailest patients were less likely to be treated with statins. (C) 2016 Elsevier Inc. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Pilotto, Alberto UNSPECIFIED UNSPECIFIED UNSPECIFIED Gallina, Pietro UNSPECIFIED UNSPECIFIED UNSPECIFIED Panza, Francesco UNSPECIFIED orcid.org/0000-0002-7220-0656 UNSPECIFIED Copetti, Massimiliano UNSPECIFIED UNSPECIFIED UNSPECIFIED Cella, Alberto UNSPECIFIED UNSPECIFIED UNSPECIFIED Cruz-Jentoft, Alfonso UNSPECIFIED UNSPECIFIED UNSPECIFIED Daragjati, Julia UNSPECIFIED UNSPECIFIED UNSPECIFIED Ferrucci, Luigi UNSPECIFIED UNSPECIFIED UNSPECIFIED Maggi, Stefania UNSPECIFIED UNSPECIFIED UNSPECIFIED Mattace-Raso, Francesco UNSPECIFIED UNSPECIFIED UNSPECIFIED Paccalin, Marc UNSPECIFIED UNSPECIFIED UNSPECIFIED Polidori, Maria Cristina UNSPECIFIED UNSPECIFIED UNSPECIFIED Topinkova, Eva UNSPECIFIED orcid.org/0000-0002-6786-4116 UNSPECIFIED Trifiro, Gianluca UNSPECIFIED UNSPECIFIED UNSPECIFIED Welmer, Anna-Karin UNSPECIFIED orcid.org/0000-0001-5819-8724 UNSPECIFIED Strandberg, Timo UNSPECIFIED UNSPECIFIED UNSPECIFIED Marchionni, Niccolo UNSPECIFIED orcid.org/0000-0002-8101-4695 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-254600
DOI:	10.1016/j.amjcard.2016.08.042
Journal or Publication Title:	Am. J. Cardiol.
Volume:	118
Number:	11
Page Range:	S. 1624 - 1631
Date:	2016
Publisher:	EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
Place of Publication:	BRIDGEWATER
ISSN:	1879-1913
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language MULTIDIMENSIONAL PROGNOSTIC INDEX; ACUTE MYOCARDIAL-INFARCTION; ADULTS; VALIDATION; GUIDELINES; THERAPY; CARE; MEN Multiple languages Cardiac & Cardiovascular Systems Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/25460