THE STORM (acute coronary Syndrome in paTients end Of life and Risk assesMent) study.
BACKGROUND
Elderly patients with coexisting frailty and multiple comorbidities frequently present to the emergency department (ED). Because non-cardiovascular comorbidities and declining health status may affect their life expectancy, management of these patients should start in the ED. This study evaluated the role of Gold Standards Framework (GSF) criteria for identifying patients with acute coronary syndromes (ACS) approaching end of life.


METHODS
All consecutive patients admitted to the ED and hospitalised with a diagnosis of ACS between May 2012 and July 2012 were included. According to GSF criteria, patients were labelled as positive GSF status when they met at least one general criterion and two heart disease criteria; furthermore, traditional cardiovascular risk scores (the Global Registry for Acute Coronary Events (GRACE) score and the Age, Creatinine and Ejection Fraction (ACEF) score) were calculated and WHOQOL-BREF was assessed. Mortality and repeat hospitalisation due to cardiovascular and non-cardiovascular causes were evaluated at 3-month and 12-month follow-up.


RESULTS
From a total of 156 patients with ACS enrolled, 22 (14%) had a positive GSF. A positive GSF was associated with higher rate of non-cardiovascular events (22.7% vs 6.7%; p=0.03) at 3 months and higher rates of both cardiovascular and non-cardiovascular events (36% vs 16.4%; p=0.04 and 27.3% vs 6.7%; p=0.009, respectively) at 12 months. In multivariate analysis, an in-hospital GRACE score was a predictor of cardiovascular events, while a positive GSF independently predicted non-cardiovascular events.


CONCLUSIONS
The GSF score independently predicts non-cardiovascular events in patients presenting with ACS and may be used along with traditional cardiovascular risk scores in choosing wisely the most appropriate treatment. The present results need to be externally validated on larger samples.
Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy.
Claudio
C
Moretti
Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy.
Giorgio
G
Quadri
Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy.
Fabrizio
F
D'Ascenzo
Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy.
Maurizio
M
Bertaina
Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy.
Federico
F
Giusto
Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy.
Sebastiano
S
Marra
Dipartimento di Scienze Mediche, Città della Salute e della Scienze, Turin, Italy.
Corrado
C
Moiraghi
Dipartimento di Medicina generale e Specialistica, Città della Salute e della Scienza, Turin, Italy.
Luca
L
Scaglione
Dipartimento di Medicina generale e Specialistica, Città della Salute e della Scienza, Turin, Italy.
Mauro
M
Torchio
Dipartimento di Scienze Mediche, Città della Salute e della Scienze, Turin, Italy.
Giuseppe
G
Montrucchio
Dipartimento di Scienze Mediche, Città della Salute e della Scienze, Turin, Italy.
Mario
M
Bo
Dipartimento di Scienze Mediche, Città della Salute e della Scienze, Turin, Italy.
Massimo
M
Porta
Dipartimento di Scienze Mediche, Città della Salute e della Scienze, Turin, Italy.
Paolo
P
Cavallo Perin
Dipartimento di Medicina generale e Specialistica, Città della Salute e della Scienza, Turin, Italy.
Carlo
C
Marinone
Dipartimento di Scienze Mediche, Città della Salute e della Scienze, Turin, Italy.
Franco
F
Riccardini
Department of Cardiology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
Javaid
J
Iqbal
Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy.
Pierluigi
P
Omedè
Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy.
Serena
S
Bergerone
Dipartimento di Scienze Mediche, Città della Salute e della Scienze, Turin, Italy.
Franco
F
Veglio
Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy.
Fiorenzo
F
Gaita
D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004636:Emergency Service, Hospital; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D011787:Quality of Health Care / Q000592:standards*; D011788:Quality of Life; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013727:Terminal Care / Q000592:standards*
acute coronary syndrome; clinical assessment