European Geriatric Medicine - Supplement 1 - Volume 7 - October 2016

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Introduction: The purpose of this study is to define survival rates and
the associated factors since the onset of Heart Failure (HF) and describe
demographic, clinical and functional characteristics.
Methods: Observational cohort study. Patients hospitalized with HF
diagnosis (incident cases) between January, 2012 and December, 2014.
The follow-up period lasted until February, 2016. Variables included:
age, sex, cardiovascular risk factors, comorbidity, New York Heart
Association functional class (NYHA), functional status, geriatric
syndromes, medication, trigger factors, left ventricular ejection
function, date of death/last contact date. Statistical analysis: SPSS
version 23.0.
Results: N:225, 127(56.4%) died (65.1% with HF exacerbation). 13.3%
died during the first hospitalization. 48 months of follow-up. 30-day
survival 79.1%, 6 months 66%, 1 year 58.2%, 2 years 43.5%.
Characteristics: Average age: 89 (SD 5), women 72%, median Charlson
Comorbidity Index 5.7 (IQR 3–7). Risk factors: arterial hypertension
83.1%, anemia 28.9%, atrial fibrillation 33.8%, kidney failure 26.2%,
Diabetes Mellitus 23.1%. Geriatric syndromes: double incontinence
25.8%, cognitive impairment 53.8%, immobility 29.3%, polypharmacy
38.1%, Barthel Index<60: 50.4%. KATZ index <2: 33.9%, Preserved
ejection fraction 89%. Median lengthof hospital stay 12 days (IQR8–21).
Cox regression analysis: Age (Hazard Ratio (HR) 1.037; confidence
interval 95%(1–1.08), male gender (HR: 1.62; CI: 1.08–2.44), urea levels
(HR: 1.004; CI:1 – 1.007), KATZ index <2 (HR: 2.26; CI:1.49–3.4).
Conclusion: Old patients with new diagnosis of HF had a one-year
survival of 58%. Age, male gender, worse functional status and high
urea are related to lower survival rates. Acute decompensated HF was
the main cause of death.
O-019
Impact of strategy and complete revascularization on prognosis
and quality of life in octogenarian patients with non-ST-elevation
myocardial infarction
C. Lopez1, E. Sanchez1, M. Lasala1, J. Urmeneta1, I. Molina1, I. Calvo1.
1Servicio de Cardiología, Hospital Universitario Miguel Servet, P° Isabel la
Católica, Zaragoza (Aragón), España
Objetives: Management of elderly patients with with non-ST-
elevation myocardial infarction (NSTE-ACS) is challenging and they
are usually uder-represented in trials. Our aimwas to assess the impact
of therapeutic strategies and complete revascularization on long-term
prognosis and quality of life (QoL) in octogenarians in our community.
Methods: We analyzed data of 224 octogenarian patients with NSTE-
ACS from 2014 –2015 according to conservative strategy (CS) vs
invasive strategy (IS). Mean follow up was 24.7 ± 5.7 months.
Primary endpoints were death, MACEs. QoL was determined with
QoL questionnaire (EuroQol 5D and EQ-5D-5L) through telephone
survey. We compared baseline characteristics, MACEs, readmissions,
death and QoL among IS group, dividing them into 2 subgroups
according to complete (CR) or not complete revascularization (NCR).
Results: 113 patients were managed using a conservative approach. IS
was associated with longer average stay (11 ± 8 vs 8 ± 9 d, p < 0.001).
There was a higher prevalence of prior stroke, chronic respiratory
disease, cognitive impairment, Charlson index, renal failure (RF) and
dependence among CS group (p < 0.05). Therewas a lower incidence of
in-hospital mortality (8.1% vs 18.6%, p = 0.017), HF (24.3% vs 40.7%;
p = 0.004), survival rate (27.9% vs 57.5%, p < 0.001), MACE (36.9% IS vs
64, 3% CS, p < 0.001) an better QoL (EQ-5D-5L: 0.79 ± 0.15 IS vs
0.72 ± 0.15 CS; p = 0.014) in IS group. There was lower mortality in
patients with Hb >12 g/dL (HR 0.217 (95% CI 0.074 to 0.638, p = 0.005)).
Revascularization was complete in 50.5% patients. RF was significantly
better among CR subgroup (≥3 CKD 48.3% vs 68.6% p = 0.013) but there
was not significant worsening of renal function in any group. NCR
group had higher rate of total readmissions (CR 1,39 ± 1,6 vs NCR
0,83 ± 1,2; p = 0.031) and readmissions in the first 6 months (CR
0.8 ± 1,33 vs NCR 0.27 ± 0.55; p = 0.012). No statistically significant
differences was found neither in mortality (CR 23.3% vs 37.3%), in the
composite event of death and major events (CR 30% vs NCR 45.1%), nor
in cardiogenic shock, HF, average stay or QoL. (EQ-5D-5L CR 0,79 ± 0,16
vs NCR 0,8 ± 0,145).
Conclusion: An invasive strategy in octogenarians with NSTE-ACS is
associated with reduced rates of mortality and major events and a
better QoL. CR was correlated with lower rate of readmissions but
there were no differences in major events, mortality or QoL.
O-020
Parathormone may influence on skin thermal flows among elderly
patients with heart failure
B. Gryglewska1, M. Fedyk-Łukasik1, A. Skalska 1, T. Grodzicki 1.
1Jagiellonian University, Kraków, Poland
Objective of the study was the assessment of contributors of skin
thermal flows among elderly patients with heart failure.
Methods: Blood pressure (BP) measurements, echocardiography, N-
terminal pro-B-type natriuretic peptide (NTproBNP), C reactive protein
(hsCRP), interleukin-6 (IL-6) and interleukin-18 (IL-18), pentraxin-3
(PPTX-3), Vitamin D (vit.D) and parathormone (PTH) were performed
in patients over 60 years with heart failure. Skin microcirculation was
assessed by laser Doppler flowmetry. Resting (RF) and thermal flow
(TF) were registered. Data were analyzed in 2 groups with NYHA I and
II (group I) and NYHA III (group II).
Results: Study population consisted of 94 persons (I – 43 and II – 51
subjects) aged 70,8 ± 8,6 years, 62,8% men. Both groups were similar
according to age, BP values, hsCRP, IL-18, PPTX-3, vit.D, PTH levels and
resting flows. Group I had higher ejection fraction (EF) than group II
(53,5 ± 15,0 vs 27,2 ± 11,2%, p < 0,001), lower NT proBNP (528 ± 839 vs
3093 ± 3260 pg/mL, p < 0,001), IL-6 (4,2 ± 3,2 vs 7,0 ± 5,9 pg/mL, p <
0,05) and thermal flows (p < 0,002). Use of ACE inhibitors was similar
in both groups, but beta-blockers (64,7% vs 86,0%, p < 0,02) and
diuretics (58,8% vs 90,7%, p < 0,001) were more frequently used in
group II than group I. TF correlated positively with EF (r = 0,3) and
negatively with NTproBNP (r = −0,29). In regression analysis EF
(beta = 0,47, p < 0,008) was only predictive variable for RF, but TF
depended on PTH (beta = 0,57, p < 0,002), Il-6 (beta = −0,5, p < 0,007)
and use of beta-blockers (beta = −0,39, p = 0,03).
Conclusions: Thermal flow properties in skin microcirculation among
elderly patients with heart failure may be related to parathormone
level.
O-021
The role of arterial stiffness and blood pressure variations in
morbidity and mortality in very old frail subjects. The PARTAGE
study
J-J. Mourad1, C. Labat2, S. Gautier2, P. Salvi 3, F. Valbusa4, O. Hanon5,
O. Toulza6, P. Manckoundia7, M. Zamboni8, Y. Rolland6, A. Benetos2.
1CHU Avicenne-APHP, Bobigny, France; 2Inserm U 1116, Nancy, France;
3San Luca Hospital, Milan, 4Sacro Cuore Hospital of Negrar, Verona, Italy;
5Broca Hospital, Paris, 6Inserm U1027, Toulouse, France; 7Hospital of
Verona, Verona, Italy 8Division of Geriatric Medicine, University of Verona,
Verona, Italy
We have previously reported in persons over 80 years old living in
nursing homes (PARTAGE study) that low pulse pressure amplification
(PPA) an marker of arterial stiffness, was associated with total
mortality and the major cardiovascular (CV) events. In subsequent
analyses we have shown that the group of subjects with systolic blood
pressure (SBP) < 130 mmHg, under >1 antihypertensive drugs, had a
greater risk of mortality as compared to all other subjects. More
recently, we have demonstrated that changes in BP between supine
and upright position in both directions (orthostatic hypotension or
orthostatic hypertension) were associated with higher risk for major
CV events The aim of the present analysis was to study the combined
effects of all these 3 arterial parameters on total mortality and major
CV events.
Method: This analysis was performed in the subjects of the PARTAGE
study with follow-up for 2 years. The parameters were studied by
using the cutoff points which according to the results of the previous
Oral presentations / European Geriatric Medicine 7S1 (2016) S1–S27 S6