Smoking cessation has immediate health benefits; however, the efficacy of smoking cessation interventions among older adults and women has received limited research attention. The original Women's Initiative for Nonsmoking (WINS) study was a randomized controlled trial that tested the efficacy of a smoking cessation intervention for Bay Area women hospitalized with cardiovascular disease. The current study, which used the WINS dataset, compares participants 62 and older with those younger than 62 years. The sample (n=277) contained 136 older smokers and 141 younger smokers. At the 6-month follow-up, 52.1% of older smokers had quit smoking compared with 40.6% of younger smokers. At the 12-month follow-up, 52.0% of older smokers had quit smoking compared with 38.1% of younger smokers. The difference at 12 months was statistically significant, and a Kaplan-Meier survival analysis further supported these findings. Clinicians should be sure to also include older smokers in smoking assessments and smoking cessation interventions.
All patients older than 65 years (184 men; mean age, 78+/-0.8 years/181 women; mean age, 82+/-0.6 years) seeking medical attention at the Lund University Hospital Emergency Clinic during a 2-year period who had an N-terminal prohormone brain natriuretic peptide (NT-proBNP) value >2000 pg/mL were followed up for survival. Mortality in the entire population was 21% after 3 months, 35% after 1 year, and 40% after 2 years. Multivariate analysis indicated that the NT-proBNP level and the New York Heart Association (NYHA) functional class were stronger predictors of mortality than were echocardiographic estimation of left ventricular ejection fraction or chest radiography. Patients who survived the first year were younger, had higher systolic blood pressure, had lower plasma creatinine, had lower inflammatory activity, and were treated with lower doses of furosemide. The results indicate that in this population, NT-proBNP level together with assessment of NYHA class gives the best prognostic information of 1-year mortality.
Antiplatelet drugs, beta-blockers, statins, and angiotensinogen-converting enzyme inhibitors reduce mortality following myocardial infarction (MI). The data on the impact of combination evidence-based medications on mortality following acute MI in elderly patients are limited. In this study, 5529 patients with MI admitted between January 2000 and December 2003 were assessed. Based on discharge use of evidence-based medications, the patients were divided into those using 0, 1, 2, 3, or 4 medications. The impact of medications on 1-year mortality was assessed for patients younger than 75 years and 75 years and older. Mean age of the patients was 63+/-13 years (71% male). The unadjusted 1-year mortality post-MI was 18.3% and 52.7% for young and elderly patients, respectively. Compared with patients with 0 medications, the adjusted odds ratio for 1-year mortality was lower in patients with 1, 2, 3, and 4 medications in both groups. Use of combination evidence-based medications was independently associated with lower 1-year post-MI mortality irrespective of age.
The American Journal of Geriatric CardiologyVolume 17, Issue 1 p. 50-52 Morphologic Features of Atherosclerotic Plaque in Occlusive Femoral Artery Disease Treated by Endarterectomy William Clifford Roberts MD, William Clifford Roberts MD From the Department of Internal Medicine, Division of Cardiology,1 the Department of Pathology,2 the Department of Surgery,3 and Baylor Heart and Vascular Institute,4 Baylor University Medical Center, Dallas, TXSearch for more papers by this author 1,2,4 Jong Mi Ko BA, Jong Mi Ko BA From the Department of Internal Medicine, Division of Cardiology,1 the Department of Pathology,2 the Department of Surgery,3 and Baylor Heart and Vascular Institute,4 Baylor University Medical Center, Dallas, TXSearch for more papers by this author 4 Gregory John Pearl MD, Gregory John Pearl MD From the Department of Internal Medicine, Division of Cardiology,1 the Department of Pathology,2 the Department of Surgery,3 and Baylor Heart and Vascular Institute,4 Baylor University Medical Center, Dallas, TXSearch for more papers by this author 3,4 William Clifford Roberts MD, William Clifford Roberts MD From the Department of Internal Medicine, Division of Cardiology,1 the Department of Pathology,2 the Department of Surgery,3 and Baylor Heart and Vascular Institute,4 Baylor University Medical Center, Dallas, TXSearch for more papers by this author 1,2,4 Jong Mi Ko BA, Jong Mi Ko BA From the Department of Internal Medicine, Division of Cardiology,1 the Department of Pathology,2 the Department of Surgery,3 and Baylor Heart and Vascular Institute,4 Baylor University Medical Center, Dallas, TXSearch for more papers by this author 4 Gregory John Pearl MD, Gregory John Pearl MD From the Department of Internal Medicine, Division of Cardiology,1 the Department of Pathology,2 the Department of Surgery,3 and Baylor Heart and Vascular Institute,4 Baylor University Medical Center, Dallas, TXSearch for more papers by this author 3,4 First published: 14 February 2008 https://doi.org/10.1111/j.1076-7460.2007.07672.xCitations: 2 William C. Roberts, MD, Baylor Heart and Vascular Institute, Baylor University Medical Center, 621 North Hall Street, Suite H-030, Dallas, TX 75226E-mail: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume17, Issue1January 2008Pages 50-52 RelatedInformation
Subgroup analysis of the Irbesartan/Hydrochlorothiazide Blood Pressure Reductions in Diverse Patient Populations (INCLUSIVE) trial evaluated the efficacy and safety of irbesartan/hydrochlorothiazide (HCTZ) fixed combinations in patients aged 65 years or older with uncontrolled systolic blood pressure (SBP) after >or= 4 weeks of antihypertensive monotherapy. The INCLUSIVE trial was a prospective, open-label, single-arm trial carried out in 119 sites. Of 844 patients completing placebo treatment, 212 were aged 65 years or older. Participants received treatment with placebo (4-5 weeks), HCTZ 12.5 mg (2 weeks), irbesartan/HCTZ 150/12.5 mg (8 weeks), and then irbesartan/HCTZ 300/25 mg (8 weeks). From baseline to week 18 (n=184, intent-to-treat population), mean change in SBP was -23.0+/-13.3 mm Hg (P<.001) and diastolic BP (DBP) was -10.9+/-7.7 mm Hg (P<.001). Mean SBP/DBP at study end was 134.0+/-14.7/75.1+/-8.4 mm Hg, and SBP, DBP, and SBP/DBP goal was achieved in 73%, 96%, and 72% of patients, respectively. Irbesartan/HCTZ combination therapy allowed SBP goal attainment in 73% of patients aged 65 years or older whose hypertension was previously uncontrolled with antihypertensive monotherapy.
The American Journal of Geriatric CardiologyVolume 17, Issue 1 p. 5-6 Progress in Treating Hypertension Michael A. Weber MD, Michael A. Weber MD Senior EditorSearch for more papers by this authorNanette K. Wenger MD, Nanette K. Wenger MD Editor in ChiefSearch for more papers by this author Michael A. Weber MD, Michael A. Weber MD Senior EditorSearch for more papers by this authorNanette K. Wenger MD, Nanette K. Wenger MD Editor in ChiefSearch for more papers by this author First published: 14 February 2008 https://doi.org/10.1111/j.1076-7460.2007.07783.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume17, Issue1January 2008Pages 5-6 RelatedInformation
The American Journal of Geriatric CardiologyVolume 17, Issue 1 p. 53-54 Twiddler's Syndrome: An Unusual Cause of Pacemaker Dysfunction Robert K. Riezebos MD, Robert K. Riezebos MD From the Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the NetherlandsSearch for more papers by this authorGysbert S. De Ruiter MD, Gysbert S. De Ruiter MD From the Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the NetherlandsSearch for more papers by this author Robert K. Riezebos MD, Robert K. Riezebos MD From the Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the NetherlandsSearch for more papers by this authorGysbert S. De Ruiter MD, Gysbert S. De Ruiter MD From the Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the NetherlandsSearch for more papers by this author First published: 14 February 2008 https://doi.org/10.1111/j.1076-7460.2007.05830.xCitations: 3 R.K. Riezebos, Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091AC Amsterdam, the NetherlandsE-mail: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Mond HG, Irwin M, Morillo C, et al. The world survey of cardiac pacing and cardioverter defibrillators: calendar year 2001. Pacing Clin Electrophysiol. 2004; 27: 955–964. 10.1111/j.1540-8159.2004.00565.x PubMedWeb of Science®Google Scholar 2 Nicholson WJ, Tuohy KA, Tilkemeier P. Twiddler's syndrome. N Engl J Med. 2003; 348: 1726–1727. 10.1056/NEJM200304243481722 PubMedWeb of Science®Google Scholar 3 Bayliss CE, Beanlands DS, Baird RJ. The pacemaker-twiddler's syndrome: a new complication of implantable transvenous pacemakers. Can Med Assoc J. 1968; 99: 371–373. CASPubMedWeb of Science®Google Scholar 4 Trojano L, Antonelli Incalzi R, Acanfora D, et al. Cognitive impairment: a key feature of congestive heart failure in the elderly. J Neurol. 2003; 250: 1456–1463. 10.1007/s00415-003-0249-3 PubMedWeb of Science®Google Scholar 5 Tonino WA, Winter JB. The twiddler's syndrome. N Engl J Med. 2006; 354: 956. 10.1056/NEJMicm050761 CASPubMedWeb of Science®Google Scholar Citing Literature Volume17, Issue1January 2008Pages 53-54 ReferencesRelatedInformation
Ethical Issue: Participating physicians failed to properly document that the patient had no reasonable expectation of recovery. This caused a delay in the initiation of discussion concerning end‐of‐life.
Patients with heart failure (HF) are at increased risk for frailty, and identification is challenging. The authors assessed the distance on the 6-minute walk test (6MWT) as a measure of frailty in 60 older HF patients (ejection fraction <or= 40%) compared with frailty phenotype (FP). Scores were dichotomized to frail (F) or nonfrail (NF), and the results of 6MWT were dichotomized to low endurance (LE) or normal endurance (NE). FP and 6MWT results were in moderate agreement (kappa=0.57, confidence interval [CI], 0.36-0.79; age-adjusted kappa=0.54, 95% CI, 0.33-0.76);25% of participants were classified as F/LE, and 55% were classified as NF/NE. Discordance was asymmetric (McNemar P=.006); 18% of participants were NF/LE. There were no differences between the NF/LE and other groups in age, sex, body mass index, or physical activity level. Results in the NF/LE group differed from those in the NF/NE group by a slower 8-foot walking speed (P=.02), weaker grip strength (P=.056), and worse renal function (P=.01) and from those in the F/LE group by faster 8-foot walking speed (P<.001). The 6MWT may be useful to identify frailty and those in transition to frailty.
The American Journal of Geriatric CardiologyVolume 17, Issue 1 p. 59-59 Wolff-Parkinson-White ECG With Pseudo-Infarct David H. Spodick MD, DSc, David H. Spodick MD, DSc From the Medical Service, St Vincent Hospital, Worcester, MASearch for more papers by this author David H. Spodick MD, DSc, David H. Spodick MD, DSc From the Medical Service, St Vincent Hospital, Worcester, MASearch for more papers by this author First published: 14 February 2008 https://doi.org/10.1111/j.1076-7460.2007.07673.x David H. Spodick, MD, DSc, Medical Service, St Vincent Hospital, 123 Summer Street, Worcester, MA 01608 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume17, Issue1January 2008Pages 59-59 RelatedInformation
The American Journal of Geriatric CardiologyVolume 17, Issue 1 p. 55-56 Increased Heart Rate: An Emerging Cardiovascular Risk Factor in Older Adults Ali Ahmed MD, MPH, Ali Ahmed MD, MPH From the Division of Gerontology, Geriatrics and Palliative Care, Geriatric Heart Failure Clinic, and Center for Heart Failure Research, University of Alabama at Birmingham and VA Medical Center, Birmingham, ALSearch for more papers by this author Ali Ahmed MD, MPH, Ali Ahmed MD, MPH From the Division of Gerontology, Geriatrics and Palliative Care, Geriatric Heart Failure Clinic, and Center for Heart Failure Research, University of Alabama at Birmingham and VA Medical Center, Birmingham, ALSearch for more papers by this author First published: 14 February 2008 https://doi.org/10.1111/j.1076-7460.2007.06606.xCitations: 1 Ali Ahmed, MD, MPH, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, 1530 3rd Avenue South, CH-19, Suite 219, Birmingham, AL 35294-2401E-mail: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume17, Issue1January 2008Pages 55-56 RelatedInformation
The authors compared the average electrocardiographic (ECG) intervals in a population of patients 80 years and older with published "normal" values. The medical records of patients who presented to the Mayo Clinic for health maintenance examinations and who had a routine ECG performed (N=702) were selected. Age; sex; rhythm; PR, QRS, and QTc intervals; incidence of cardiac disease; and presence of interval-prolonging medication were recorded. Reference ranges were estimated from the data and compared with standard cutoffs for prolonged intervals. Interval values were significantly higher in men. Reference ranges were established separately for both sexes based on the subset of 578 patients without a history of cardiac disease and not taking interval-prolonging medication. In all instances, the ranges were higher than the recommended cutoffs. The upper limits for prolonged PR, QRS, and QTc intervals were found to be significantly higher in a population of patients older than 80 years.
Frailty is a progressive physiologic decline in multiple body systems marked by loss of function, loss of physiologic reserve, and increased vulnerability to disease and death. Until recently, frailty has been poorly defined in the medical literature. One currently accepted definition of frailty is having 3 of the following 5 attributes: unintentional weight loss, muscle weakness, slow walking speed, easy exhaustion, and low physical activity. The mechanisms that underline frailty remain unclear. Significantly higher levels of markers of inflammation and the clotting cascade have been found in frail persons compared with nonfrail persons. These markers are also risk factors for the development of coronary heart disease. Recent research has indicated that frailty is a clinical manifestation of cardiovascular disease, especially of heart failure. Thus, understanding the connection between frailty and cardiovascular disease may lead to development of new interventions that will prevent and reverse the associated morbidity and mortality.
Dyslipidemia conveys a major increased risk of future cardiovascular events in older persons. Data from large randomized controlled trials confirm that statin therapy is as beneficial in older adults as it is in younger persons in both primary and secondary prevention. National guidelines support the use of statin therapy to reduce low-density lipoprotein cholesterol in older adults, with the recommended goal of < 100 mg/dL in high-risk patients and an optional goal of < 70 mg/dL in very high-risk patients. In the majority of high-risk older patients, these levels of low-density lipoprotein cholesterol can be achieved with initial low doses of an efficacious statin, but in some clinical situations, combination therapy may be considered. Moreover, statins appear to be safe and well tolerated in older age groups. Because of heightened risks of drug-drug interactions, the likelihood of polypharmacy in seniors, and issues of tolerability and convenience, monotherapy with low doses of an efficacious statin may be preferable to combination therapy in elderly individuals.
The authors used population-based myocardial infarction (MI) register data to examine trends in incidence, case fatality, treatment strategies of MI, and coronary heart disease (CHD) mortality in persons aged 75 to 99 years in 4 areas of Finland during 1995 through 2002. This age group contributed 53% (n=13,977) of all CHD events, and 65% occurred in women. CHD mortality declined among men annually by 3.5% and 1.0% in the 75- to 84-year-old and 85- to 99-year-old age groups, respectively. Among women, it declined by 2.2% per year in the 75- to 84-year-old age group but increased by 1.3% per year in the 85- to 99-year-old age group. MI attack rate did not change in men but increased significantly in women aged 85 to 99 years. Clinical management of MI in elderly patients was more conservative than in middle-aged patients. In conclusion, one-half of all CHD events occur among persons aged 75 years or older, and elderly patients with CHD represent an increasing burden to the health care system.
