Systematic re-evaluation of the diagnosis and treatment of coronary artery disease in hospitalized elderly: Impact on medication underuse. The multicenter IRIDIA study |
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| Authors: | S Legrain S Delpierre S Lacaille P Duc D Lieberherr D Bonnet H Lahjibi-Paulet A Gouronnec J Boddaert B Durand-Gasselin C Roy V Faucounau P-G Steg F Tubach |
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| Institution: | 1. Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden;2. Section of Anaesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden |
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| Abstract: | Despite benefit of secondary prevention of coronary artery disease, evidence-based treatment are underused in very elderly patients. The objective of IRIDIA study is to evaluate feasibility of improving on the use of coronary artery disease evidence-based therapies through a intervention, based on diagnosis and treatment reassessment, in elderly inpatients.MethodsDesign: prospective cohort study with one-year follow-up. Setting: six acute care geriatric wards in France. Participants: consecutive inpatients ≥ 75 years old with a supposed diagnosis of coronary artery disease (CAD).InterventionFirst step: reassessment of CAD diagnosis using coronary-oriented investigations. Second step: optimization of CAD treatment in accordance with international guidelines. Primary outcome: change in use of the recommended CAD treatment between admission and discharge. Secondary outcome: diagnosis optimization between admission and discharge.ResultsTwo hundred and sixty-one participants (mean age 87 years IQR: 83–92 years]) with a high prevalence of comorbidities, cognitive impairment, and disability. The CAD diagnosis was considered confirmed at inclusion in 138 of the 261 patients (53%) with an evident underuse of β-blockers and antiplatelet agents. The impact of the intervention on CAD diagnosis was 40%; for 74 patients, the diagnosis remained uncertain. For patients with confirmed CAD (n = 178), the treatment optimization resulted in a increase in use of evidence-based therapy, with rates of 66% for β-blockers and 79% for antiplatelet agents, without significant complications at 1 year.ConclusionThis multicenter study demonstrated the feasibility of improving on the use of CAD evidence-based therapies through a simple intervention, including CAD diagnosis optimization and treatment reassessment, in a very elderly population with comorbidities in an acute-care setting.Trial registrationClinical Trials. gov Identifier: NCT00224575. |
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