BACKGROUND: A mismatch between myocardial oxygen supply and demand is the most common cause of ischemic myocardial injury in older persons. The subendocardial viability ratio (SEVR) can usefully estimate the degree of myocardial perfusion relative to left-ventricular workload. The aim of the present study was to evaluate the ability of SEVR to predict long-term mortality in the older population. Additionally, we aimed to identify the SEVR cutoff value best predicting total mortality.
METHODS: This is a multicenter, longitudinal study involving a large population of individuals older than 80 years living in nursing homes. Patients with cancer, severe dementia, and very low level of autonomy were excluded from the study. Participants were monitored for 10 years. Adverse outcomes were recorded every 3 months from inclusion to the end of the study. SEVR reflects the balance between subendocardial oxygen supply and demand, and was estimated non-invasively by analyzing the carotid pressure waveform recorded by applanation arterial tonometry.
RESULTS: A total of 828 people were enrolled (mean age: 87.7 ± 4.7 years, 78% female). 735 patients died within 10 years and 24 were lost to follow-up. SEVR was inversely associated with mortality at univariate Cox-regression model (risk ratio, 0.683 per unit increase in SEVR; 95% confidence interval (CI) [0.502-0.930], p = 0.015) and in a model including age, sex, body mass index, Activity of Daily Living index and Mini-Mental State Examination score (risk ratio, 0.647; 95% CI [0.472-0.930]). The lowest tertile of SEVR was associated with higher 10-years total mortality than the middle (p < 0.001) and the highest (p < 0.004) tertile. A SEVR cutoff value of 83% was identified as the best predictor of total mortality.
CONCLUSIONS: SEVR may be considered as a marker of \"cardiovascular frailty.\" An accurate non-invasive estimation of SEVR could be a useful and independent parameter to assess survival probability in very old adults.
BACKGROUND: NCT00901355, registered on ClinicalTrials.gov website.

This study was designed as a pilot test to analyze the effect of patient-centered care (PCC) bundle intervention on perioperative respiratory complications and other outcomes in hip fracture patients aged ≥80. Between Jan 2018 and Dec 2019, 198 patients comprised the routine care group and 187 comprised the PCC bundle group. After propensity score matching, 151 remained in each group. Incidence of perioperative respiratory complications in the PCC bundle group was significantly lower than in the routine care group (all P < 0.05). Furthermore, significant reductions were observed in surgery delay, length of stay, incidence of arrhythmia, hypoproteinemia, and electrolyte disturbance (all P < 0.05) in the PCC bundle group. Age-Adjusted Charlson Comorbidity Index score was related, but only weakly, to length of stay and the number of perioperative complications. These results suggested that the PCC bundle might be a more suitable care modality for patients ≥80 with hip fracture.

OBJECTIVE: To detect the validity of the Global Registry of Acute Coronary Events (GRACE) risk score in predicting acute myocardial infarction (AMI) mortality of Chinese inpatients aged 80 and over.
METHODS: Hospital mortality was defined as all-cause death rate of patients during hospitalisation. Using GRACE risk score to predict death risk, both discrimination (C statistic) and calibration (the predicted vs observed mortality based on the population with predicted risks) were evaluated.
RESULTS: Three hundred eighty-six patients presenting with ST segment elevation AMI (STEMI) and non-STEMI were enrolled. The GRACE risk score ranged between 151 and 297, and the mortality was 23.3%. The overall discriminatory capacity of the GRACE model was high (C statistic 0.767, CI: 0.712-0.822). There was a high correlation (R(2) = 0.833) between the predicted and observed hospitalised AMI mortality.
CONCLUSIONS: The GRACE score is a useful risk prediction model for hospital mortality of Chinese AMI patients aged 80 and over.