Barthel Index as a Predictor of 1-Year Mortality in Very Elderly Patients Who Underwent Percutaneous Coronary Intervention for Acute Coronary Syndrome: Better Activities of Daily Living, Longer Life.

Abstract

BACKGROUND:

Percutaneous coronary intervention (PCI) is safe and effective in very elderly patients, defined as those who are age ≥85 years, with acute coronary syndrome (ACS). However, the prognostic factors remain unknown. The association between activities of daily living (ADL) and the prognosis after PCI has not yet been investigated.

HYPOTHESIS:

Better ADL is associated with better 1-year prognosis.

METHODS:

This retrospective study included 91 consecutive very elderly patients with ACS. We calculated the Barthel Index (BI) as an indicator for ADL. Patients were classified into 2 groups according to BI: high BI (≥85) and low BI (<85). The BI was assessed both on admission (pre-BI) and at discharge (post-BI).

RESULTS:

In the 91 patients (mean age, 88.2 ± 3.0 years, 52% male), 1-year mortality was 33%. The Cox regression model demonstrated that low pre-BI was not a risk factor for 1-year mortality (hazard ratio: 0.73, 95% confidence interval [CI]: 0.30-1.78, P = 0.490). However, post-BI was significantly associated with 1-year mortality (hazard ratio: 0.25, 95% CI: 0.11-0.57, P = 0.001). The 1-year mortality of the high and the low post-BI group was estimated as 21% (95% CI: 12%-35%) and 62% (95% CI: 42%-82%), respectively. A 5-unit decrease in post-BI was related to a 1.10-fold increased risk for 1-year mortality (95% CI: 1.05-1.15, P < 0.001).

CONCLUSIONS:

Activities of daily living at discharge, although not before admission, may be a useful predictor for 1-year mortality in very elderly patients undergoing PCI for ACS.

• Authors: Satoshi Higuchi, Yusuke Kabeya, Kenichi Matsushita, Hiroki Taguchi, Haruhisa Ishiguro, Hideyasu Kohshoh, Hideaki Yoshino
• Journal: Clinical cardiology (Clin Cardiol) Vol. 39 Issue 2 Pg. 83-9 (Feb 2016) ISSN: 1932-8737 [Electronic] United States
• PMID: 26720494 (Publication Type: Comparative Study, Journal Article)
• Copyright: © 2015 Wiley Periodicals, Inc.

Topics

• Activities of Daily Living
• Acute Coronary Syndrome (diagnosis, mortality, psychology, therapy)
• Age Factors
• Aged, 80 and over
• Chi-Square Distribution
• Decision Support Techniques
• Female
• Geriatric Assessment (methods)
• Hospital Mortality
• Humans
• Kaplan-Meier Estimate
• Male
• Percutaneous Coronary Intervention (adverse effects, mortality)
• Predictive Value of Tests
• Proportional Hazards Models
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Time Factors
• Treatment Outcome