title: Impact of functional decline on outcome in elderly patients with acute coronary syndromes.
abstract: BACKGROUND
  Management of acute coronary syndromes in elderly patients is poorly defined.
  
  
  OBJECTIVE
  To assess the impact of functional decline on all-cause mortality in elderly patients with acute coronary syndromes.
  
  
  METHODS
  Clinical data, including the Global Registry of Acute Coronary Events score and assessment of functional status obtained by using the Katz scale, were prospectively collected on 272 patients 70 years or older hospitalized for acute coronary syndromes. All-cause mortality was assessed at 6 months, and longer term outcome data were obtained.
  
  
  RESULTS
  Mean age of the patients was 78 years (SD, 6), and 58% were men. A total of 28% had functional decline. Six months after the index hospitalization, 38 patients had died. Another 29 patients died during a median follow-up of 611 days after the initial 6 months. Functional decline was associated with both 6-month (hazards ratio, 3.63; 95% CI, 1.91-6.88; P < .001) and long-term (hazards ratio, 2.69; 95% CI, 1.28-5.64; P = .009) outcomes. Functional decline remained associated with both 6-month and long-term outcomes in multivariate analysis and was systematically selected in the most predictive multivariate models for 6-month and long-term mortality. The multivariate model including the Global Registry of Acute Coronary Events score and functional decline was predictive of 6-month mortality, but the combination of functional decline and biological data was more predictive of long-term mortality than was a model combining functional decline and the Global Registry score.
  
  
  CONCLUSIONS
  Functional decline in elderly patients with acute coronary syndromes is predictive of poor outcomes.
authors.affiliation: Centre Hospitalier Régional et Universitaire de Lille, Lille, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Decourcelle
authors.forename: Sylvestre
authors.initials: S
authors.lastname: Maréchaux
authors.forename: Claire
authors.initials: C
authors.lastname: Pinçon
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Barrailler
authors.forename: Thierry H
authors.initials: TH
authors.lastname: Le Jemtel
authors.forename: Pierre Vladimir
authors.initials: PV
authors.lastname: Ennezat
mesh_terms: D000203:Activities of Daily Living; D054058:Acute Coronary Syndrome / Q000401:mortality*; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D015233:Models, Statistical; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome