Geriatric syndromes in elderly patients with myocardial infarction
Authors: Malchikova S V , Trushnikova N S , Maksimchuk-Kolobova N S , Kazakovtseva M V 
Published: October 2021

Abstract

Introduction
The average age of patients with acute coronary syndrome ACS has been progressively increasing in recent decades. Recommendations for the management of patients with ACS emphasize the importance of a patient-oriented approach, including aged 75 and over.

Purpose
To assess the geriatric status in elderly patients with myocardial infarction MI.

Methods
92 patients with MI were studied, mean age 81.6±4.2. Questionnaire “age is no disqualification”, The Short Physical Performance Battery, Mini Nutritional Assessment- MNA, Barthel Activities of daily living Index, Instrumental Activities of Daily Living, gait velocity, “Get up and go”, dynamometry, Mini Mental State Examination- MMSE, clock drawing test, geriatric depression scale- GDS. Statistical data processing was performed using the Statistica for Windows ver 10.0.

Results
The frailty syndrome FS was in 38.0% patients, preasthenia in 17.4%, 44.6% without FS. Impairment of memory, understanding, orientation was in 85.7% fragile, 87.5% of pre-fragile, 36.6% in strong, p&lt;0.001. In FS group, visual and hearing impairments were 85.7% versus 50.0% with preasthenia, 24.4% without FS (p&lt;0.001). Episodes of urinary incontinence were 7.3% in strong, pre-fragile – 62.5%, fragile – 57.1%, p&lt;0.001. Difficulty gait- 43.8% in preasthenia, 19.5% without FS, in FS group 68.6%, p&lt;0.001. 34.1% of strong, 75% of pre-fragile and 82.9% of fragile used a walking stick. The majority of strong – 85.4% and preasthenia – 81.3% took daily walks. Constant pain is experienced by 9.8% strong, 6.3% pre-fragile, 31.4% fragile. According to MNA data, the lowest scores were in fragile – 23.2±2.5, without FS – 26.5±1.7 (p=0.000), 25.4±1,6 in pre-fragile (p=0.002). The risk of malnutrition was in 7.3% without FS, 18.8% in preasthenia, 54.3% with FS. The baseline PA in without FS group and preasthenia was the same, the Barthel Index – 100 [100; 100], with FS – 95 [85; 100]. A pronounced dependence on outside help experienced 5.7%, 25.7% moderate, 40% mild. The time to complete the “Get up and go” averaged 11.8±4.2 for strong, 16.3±5.4 for preasthenia, 20.3±6.3 for fragile. The average pinch strength in the group without FS was 18.8±8.1 kg of the right hand and 16.3±7.3 kg of the left hand, it is higher than in preasthenia 11.1±5.6 kg and 8.3±3.9kg, p=0.000), FS 10.0±4.7kg and 8.5±4.6kg, p=0.000. 36.6% without FS, 12.5% with preasthenia, 8.6% with FS had no cognitive deficiency and scored 28–30 points on the MMSE. Strong received 8.5 [8; 9] in clock drawing test, preasthenia – 7.6 [7; 9], fragile – 6.7 [6; 8.5]. GDS revealed probable depression in 34.1% without FS, in 75% preasthenia, 88.2% with FS.

Conclusion
In patients with MI and FS, geriatric syndromes were significantly more often detected, reflecting disorders of physical and mental health and performance status, which can serve as additional criteria for predicting the risks of unfavorable outcomes in MI in elderly and long-livers.

Funding Acknowledgement
Type of funding sources: None.