title: Non-cardiac comorbidities in the very elderly with acute myocardial infarction: prevalence and influence on management and in-hospital mortality.
abstract: BACKGROUND
  Acute myocardial infarction (AMI) in the very elderly is common and is associated with increased mortality. Despite this, the majority of such patients do not receive the most effective cardiovascular therapies. The presence of non-cardiac comorbidities constitutes an additional challenge to the management of AMI in very elderly patients.
  
  
  OBJECTIVE
  To determine the prevalence of non-cardiac comorbidities in the very elderly (age > or = 80 years) with AMI and how it influences their management and in-hospital mortality.
  
  
  METHODS
  A total of 132 patients consecutively admitted with a diagnosis of AMI from January 2005 to December 2007 were analyzed retrospectively. Two groups were considered: patients with non-cardiac comorbidities (group 1) and those without non-cardiac comorbidities (group 2). Cardiovascular risk factors and non-cardiac comorbidities (anemia, chronic obstructive pulmonary disease, chronic renal failure, cancer, neurologic or psychiatric disorders, and prostatic hyperplasia in men) were recorded. Use of an invasive strategy and the therapy prescribed at discharge were compared between the groups.
  
  
  RESULTS
  Non-cardiac comorbidities were found in 56.8% of patients, with the following prevalences: anemia 18.2%; chronic obstructive pulmonary disease 11.4%; chronic renal failure 25.8%; cancer 3.0%; neurologic or psychiatric disorders 11.4%; and prostatic hyperplasia 20.5%. Patients with comorbidities had longer hospital stay than those without (12.1 +/- 5.5 and 10.1 +/- 3.5 days, respectively; p = 0.014). An invasive strategy, with coronary angiography, was used in 12.1% of patients, with no differences between groups (12.3% in patients without comorbidities and 12.0% in those with, p = 0.82). At discharge, more than 70% of the patients were prescribed aspirin, statins and nitrates. With the exception of non-dihydropyridine calcium antagonists, which were more frequently prescribed in patients with comorbidities (15.9% vs. 2.2%; p = 0.04), no other differences in therapy were observed between the two groups.
  
  
  CONCLUSIONS
  In our population of very elderly patients, the prevalence of non-cardiac comorbidities was high (56.8%), but this did not significantly influence the management of these patients.
authors.affiliation: Serviço de Cardiologia do Hospital do Espírito Santo, Evora, Portugal. bcpicarra@hotmail.com
authors.forename: Bruno Cordeiro
authors.initials: BC
authors.lastname: Piçarra
authors.forename: Ana Rita
authors.initials: AR
authors.lastname: Santos
authors.forename: Margarida
authors.initials: M
authors.lastname: Celeiro
authors.forename: Angela
authors.initials: A
authors.lastname: Bento
authors.forename: Pedro
authors.initials: P
authors.lastname: Dionísio
authors.forename: Pedro
authors.initials: P
authors.lastname: Semedo
authors.forename: Renato
authors.initials: R
authors.lastname: Fernandes
authors.forename: Agostinho
authors.initials: A
authors.lastname: Caeiro
authors.forename: Rui
authors.initials: R
authors.lastname: Soares
authors.forename: Manuel
authors.initials: M
authors.lastname: Trinca
authors.forename: António
authors.initials: A
authors.lastname: Jara
mesh_terms: D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D015995:Prevalence; D012189:Retrospective Studies