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Key conclusions:
Preliminary results show a high percentage of
elderly living in nursing homes at risk of undernutrition and this is
associated with lower functionality and depression. This study
highlights the importance of promoting autonomy and investing in
mental health promotion, as well as in supporting an adequate
nutrition in nursing home residents.
Area: Cardio-geriatrics
O-015
Stop vasodepressor drugs in reflex syncope: a randomized
controlled trial
F. Tesi
1
, A. Ungar
1
, D. Solari
2
, M. Rafanelli
1
, M. Unterhuber
3
, G. Gaggioli
4
,
M. Tomaino
3
, M. Brignole
2
.
1
Syncope Unit, Cardiology and Geriatric
Medicine, University of Florence and Azienda Ospedaliero- Universitaria
Careggi, Florence,
2
Department of Cardiology, Ospedali del Tigullio,
Lavagna,
3
Department of Cardiology, Ospedale Bolzano,
4
Department of
Cardiology, Ospedale Villa Scassi, Genova, Italy
Objectives:
Most elderly patients affected by reflex vasodepressor
syncope take one or more hypotensive drugs. The role of these drugs in
causing syncope has not yet been established. The objective of the
study is to investigate the clinical effects of discontinuing vasoactive
drugs in patients affected by vasodepressor reflex syncope.
Methods:
Randomized, parallel, prospective, safety/efficacy study
conducted from January 2014 to December 2015 in 4 general hospitals.
Of 328 initially screened participants, 58 patients (mean [SD] age
74 ± 11 years) affected by vasodepressor reflex syncope, which was
reproduced by tilt testing (#54) or carotid sinus massage (#4), were
enrolled (247 were excluded by inclusion/exclusion criteria; 23
declined to participate).
Results:
Of the 58 patients enrolled, 32 were randomized to stop/
reduce and 26 to continue vasoactive drugs therapy. Of these, 55
participants completed the trial. After 1 month, systolic blood pressure
was significantly higher in the
“
stop/reduce
”
group than in the
“
continue
”
group, in both supine (141 ± 13 mmHg vs 128 ± 14 mmHg;
p = 0.004) and standing (133 ± 13 mmHg vs 122 ± 15 mmHg; p = 0.02)
positions. During a mean follow-up of 9 ± 7 months, the primary
combined end-point occurred in 6
“
stop/reduce
”
patients (19%): 2 had
syncope, 3 pre-syncope and 1 heart failure. Conversely, it occurred in
12
“
continue
”
patients (50%): 9 had syncope, 2 pre-syncope and 1
cerebral transient ischemic attack. The hazard ratio was 0.37 (95% CI
0.14
–
0.95).
Conclusion:
Recurrence of syncope and pre-syncope can be safely
prevented by discontinuing/reducing vasoactive therapy in most
elderly patients affected by reflex vasodepressor syncope.
O-016
Recommendations for non-pharmacological interventions for
chronic heart failure in older patients. Applying the GRADE
approach
J.M. Rimland
1
, I. Abraha
1
, F.M. Trotta
1
, G. Dell
’
Aquila
1
, A. Cruz-Jentoft
2
,
R. Soiza
3
, M. Petrovic
4
, A. Gudmusson
5
, D. O
’
Mahony
6
, A. Cherubini
1
.
1
Italian National Research Center on Aging, Ancona, Italy;
2
Hospital
Universitario Ramon y Cajal, Madrid, Spain;
3
Woodend Hospital,
Aberdeen, UK;
4
Ghent University Hospital, Ghent, Belgium;
5
Landspitali
University Hospital Reykjavik, Reykjavik, Iceland;
6
University College
Cork, Cork, Ireland
Introduction:
Explicit and transparent recommendations were
developed for non-pharmacological interventions for chronic heart
failure in older adults based on the Grading of Recommendations,
Assessment, Development and Evaluation (GRADE) approach to rating
the quality of evidence and the strength of recommendations.
Methods:
A multidisciplinary panel was constituted comprising
geriatricians, nurses and a clinical epidemiologist. The evidence was
compiled from a systematic search of reviews published from 2010 to
October 2015. A Delphi method was used to establish critical and
important outcomes. The GRADE approach was used to rate the
evidence and to formulate recommendations.
Results:
The critical outcomes, determined through the Delphi
method, were all-cause mortality, all-cause hospital admission/
rehospitalization and health-related quality of life. The most frequent
non-pharmacological intervention was exercise-based cardiac
rehabilitation followed by telemonitoring. Based on moderate
quality evidence, the panel formulated a strong recommendation for
exercise-based cardiac rehabilitation to reduce hospitalization (15
RCTs; 1,328 participants; RR = 0.75, 95% CI 0.62
–
0.92) and a weak
recommendation (low quality evidence) against exercise-based
cardiac rehabilitation to reduce mortality (24 RCTs; 1,871 participants;
RR = 0.93, 95% CI 0.69
–
1.27). A strong recommendation (moderate
quality evidence) was generated for the use of telemonitoring to
reduce mortality (17 RCTs; 3,740 participants; RR = 0.80, 95% CI 0.68
–
0.94) and a weak recommendation (low quality evidence) against this
intervention to reduce hospitalization (13 RCTs; 3,332 participants;
RR = 0.95, 95% CI 0.89
–
1.01).
Conclusions:
The panel developed the most recent, systematic and
transparent recommendations for non-pharmacological interventions
for chronic heart failure.
Funding: European Union Seventh Framework Program (FP7/2007
–
2013), grant agreement n° 305930 (SENATOR).
O-017
Delayed BP recovery on standing is associated with unexplained
and injurious falls
C. Finucane
1
, M.D.L. O
’
Connell
2
, O. Donoghue
2
, K. Richardson
3
,
G.M. Savva
3
, R.A. Kenny
2,3
.
1
Mercer
’
s Institute for Successful Ageing,
2
The
Irish Longitudinal Study on Ageing, Dublin, Ireland;
3
Norwich Innovation
Park, University of Easy Anglia, United Kingdom
Introduction:
Cardiovascular disorders are recognised as important
modifiable risk factors for falls. However the association between falls
and orthostatic hypotension (OH) remains ambivalent, particularly
because of poor measurement methods of previous studies. Our goal
was to determine for the first time towhat extent OH (and variants) are
risk factors for incident falls, unexplained falls (UF), injurious falls (IF)
and syncope using dynamic blood pressure (BP) measurements in a
population study.
Methods:
Community dwelling adults resident in Ireland aged
≥
50
years were recruited to waves 1 and 2 of the Irish Longitudinal Study
on Ageing (TILDA). Continuous BP recordings measured during active
stands were analysed. Persistent OH and variants (initial OH and
impaired orthostatic BP stabilization OH(40)) were defined using
dynamic BP measurements. Associations with the number of falls, UF,
IF and syncope reported two years later were assessed using negative
binomial and modified Poisson regression.
Results:
4,128 participants were studied, mean age 61.5(8.1) years,
52.9% female. OH(40) was associated with increased relative risk of UF
(RR:1.5195%CI:1.02
–
2.24). Persistent OHwas associated with all-cause
falls (IRR:1.41 95%CI:1.01
–
1.97), UF (RR:1.81 95%CI:1.06
–
3.09), and IF
(RR:1.57 95%CI:1.11
–
2.23) and increases the absolute risk of IF by 5%.
Conclusion:
Impairments in orthostatic BP control are clinically
relevant independent risk factors for falls, UF, and IF. Impaired BP
stabilisation and persistent OH are easily measurable biomarkers and
should be considered in the future assessment of falls risk in older
adults.
O-018
Survival analysis of older patients with new diagnosis of heart
failure hospitalized in an acute care unit
J. Marttini Abarca, L. Fernandez Arana, E. Lueje Alonso, P. Gil Gregorio.
Clinico San Carlos Hospital, Madrid, Spain
Oral presentations / European Geriatric Medicine 7S1 (2016) S1
–
S27
S5