Intervention and in-hospital pharmacoterapies in octogenarian with acute coronary syndrome: a 10-year retrospective analysis of the Malaysian National Cardiovascular Database (NCVD) registry

Abstract

Background: Octogenarians and beyond have often been neglected in the populational study of disease despite being at the highest point of non-modifiable disease risk burden and the fastest-growing age group for the past decade. This study examined the characteristics and in-hospital management of octogenarian patients with acute coronary syndrome (ACS) in a multi-ethnic, middle-income country in South East Asia.

Method: This retrospective study utilised the Malaysian National Cardiovascular Disease- ACS (NCVD-ACS) registry. Consecutive patient data of those ≥80 years old admitted with ACS at 24 participating hospitals from 2008 to 2017 (n = 3162) were identified. Demographics, in-hospital intervention, and evidence-based pharmacotherapies over the 10-years were examined and compared across groups of interests using the Chi-square test. Multivariate logistic regression was used to calculate the adjusted odds ratio of receiving individual therapies according to patients' characteristics.

Results: Octogenarians made up 3.8% of patients with ACS in the NCVD-ACS registry (mean age = 84, SD ± 3.6) from 2008 until 2017. The largest ethnic group was Chinese (44%). Most octogenarians (95%) have multiple cardiovascular risk factors, with hypertension (82%) being the main. Non-ST-elevation myocardial infarction (NSTEMI) predominated (38%, p < 0.001). Within the 10-year, there were positive increments in cardiovascular intervention and pharmacotherapies. Only 10% of octogenarians with ACS underwent percutaneous coronary intervention (PCI), the majority being STEMI patients (17.5%; p < 0.05). More than 80% were prescribed aspirin (91.3%) either alone or combined, dual antiplatelet therapy (DAPT) (83.3%), anticoagulants (89.7%) and statins (89.6%), while less being prescribed angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (47.6%) and beta-blockers (43.0%). Men were more likely to receive PCI than women (adjusted Odds Ratio (aOR): 0.698; 95% CI: 0.490-0.993). NSTEMI (aOR = 0.402, 95% CI: 0.278-0.583) and unstable angina (UA) (aOR = 0.229, 95% CI: 0.143-0.366) were less likely to receive PCI but more likely given anticoagulants (NSTEMI, aOR = 1.543, 95% CI: 1.111-2.142; UA, aOR = 1.610, 95% CI: 1.120-2.314) than STEMI. The presence of cardiovascular risk factors and comorbidities influences management.

Conclusion: Octogenarians with ACS in this country were mainly treated with cardiovascular pharmacotherapies. As the number of octogenarians with ACS will continue to increase, the country needs to embrace the increasing use of PCI in this group of patients.

Keywords: Cardiovascular disease; Intervention; Mortality; Octogenarians; Pharmacoepidemiology; Pharmacotherapies.

Fig. 1

Frequencies of admission for octogenarian patients with ACS over total admission of patients with ACS in the NCVD-ACS registry (2008–2017). Gender distribution for octogenarian patients with ACS in the NCVD-ACS registry (2008–2017). 10-years cumulative N = 3162 comprises of 1654 octogenarians men and 1508 octogenarians women

Fig. 2

a: 10-years cumulative frequencies of PCI and in-hospital evidence-based pharmacotherapies for octogenarians with ACS in the NCVD-ACS registry (2008–2017). In-hospital pharmacotherapies include aspirin (monotherapy or as combined therapy), dual antiplatelet therapy (DAPT), anticoagulants, statins, ACE inhibitors(ACEIs)/angiotensin II receptor blockers (ARBs) and beta- blockers are individually illustrated. b: Frequencies of PCI and in-hospital evidence-based pharmacotherapies prescribed to octogenarians with ACS in the Malaysian NCVD-ACS registry (2008–2017). In-hospital pharmacotherapies include aspirin (monotherapy or as combined therapy), dual antiplatelet therapy (DAPT), anticoagulants, statins, ACE inhibitors(ACEIs)/angiotensin II receptor blockers (ARBs) and beta- blockers. Linear trend test was used to determine the P-values. Frequencies of PCI and in-hospital evidence-based pharmacotherapies in octogenarians with ACS in the NCVD-ACS registry (2008–2017)