Morbidity Research Paper

INTRODUCTION

Ischemic heart disease is the leading cause of death worldwide in hospitalized patients[1]. Cardiovascular morbidity and mortality increases exponentially from 75 years-old [2]. Approximately, 30% of patients admitted for acute myocardial infarction (AMI) are over 75 years old, and represent 50% of ischemic heart disease mortality [2,3]. Elderly patients have a higher risk for AMI short- and long-term mortality than younger patients [4,5]. On the other hand, nonagenarians with AMI non admitted to Coronary Care Unit (CCU) are increasing progressively [6]. Factors associated with the admission decision are not clearly understood, and the evidence is scarce. Older patients non admitted to CCU are treated less frequently with invasive

Mostly of previous studies in patients with AMI, applied the complete version of Charlson index [21,22]. In our work, we used the modified Charlson index [13], since it is simple and validated in elderly population- comcretely with AMI.

A higher rate of the male gender and dyspnea in AMI elderly with comorbidity, has been consistently reported [21,22,30,31]. It could determine an underdiagnosis, undertreatment or therapeutic failure in clinical practice, which is frequent in patients with these basal characteristics. No differences were observed for psychofunctional basal status and principal prognostic factors, anyway limitations of the study (as discussed below) should be considered.

The presence of comorbidity, did not an influence in short- and long-term mortality. It is controversial according to previous literature, because comorbidity is defined as a prognostic factor [32,33], as well as other studies demonstrate a poor prediction value in very elderly [34]. Probably, the use of the modified Charlson index to assess comorbidity, would be more accurate to determine short-term mortality and other outcomes than long-term mortality. Furthermore, hemoglobin levels or anemia (that are not included in usual comorbidity indexes), perhaps have a stronger impact on

In this sense, patients with associated comorbidity presented more frequently atypical symptoms at presentation, whereas in patients with an active functional status chest pain was the common initial symptom. Moreover, the impact of these factors on the coronary care decisions were different. Although comorbidity had no effects in the decision-making, dyspnea and basal functional status were major factors to determine CCU admission. Consequently, to detect patients with an active functional status and atypical presentation represents a challenge for clinicians, mainly in relation to patients with comorbidity in which this presentation is commonly observed., Furthermore, AMI in nonagenarians patients would be correctly assessed from a holistic point of view (biopshycosocial), due to the risk of misdiagnosis, mistreatment and prognosis repercussion. In this context, an accurate patient selection based on possible benefits of intensive treatment remains crucial. Future studies to define plausible selection criteria should be