- Email: [email protected]
Health and disease incidence in Irish, elderly subjects: Baseline findings from the ELDERMET project
8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S33–S143
are underprescribed in this indication. We hypothesize that, in patients ≥ 75-years-old, some geriatric characteristics might contribute to the explanation of this underprescription. The objectives were: to study the prevalence of AF in consecutive geriatric patients admitted in an emergency ward and to analyse the barriers to the prescription of anticoagulation therapy. Methods.– Patients ≥ 75 years old admitted in an emergency room of a general hospital were studied between June and December 2011. Medical history, level of indication for treatment with AVK (CHADS2 score), comprehensive geriatric assessment (scales to assess frailty, depression, disability, malnutrition, and comorbidities), and blood analyses were collected prospectively. Results.– One hundred forty two out of 995 patients presented AF (14%). Among patients for whom anticoagulation was indicated (73% of all patients), only 61% were treated. Higher proportions of patients with recent (≤ 6 months) hospitalization, co-medication with digoxine, and taking of greater than three different drugs were observed in the group with anticoagulation therapy than in controls. Conclusions.– Neither the results of the CHADS2 score nor the geriatric characteristics were associated with the decision to administrate or not anticoagulation therapy. More research is needed to identify and clarify the relative importance of patient-, physician- and healthcare system-related barriers to the prescription of AVK therapy in older patients with AF. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.020 P020
Atrial fibrillation in old athletes – the Birkebeiner ageing study M. Myrstad a , A.K. Gulsvik b , A.H. Ranhoff a,∗ Medical Department, Diakonhjemmet Hospital, Oslo, Norway b Medical Department, Oslo University Hospital Ulleval, Oslo, Norway
a
Introduction.– Long-term endurance training seems to predispose to lone atrial fibrillation (LAF) in middle-aged athletes. Our purpose was to explore the prevalence of atrial fibrillation (AF), LAF and risk factors in old cross-country skiers with a history of strenous endurance training, and to compare them with controls from the general population. Methods.– In the pilot-study, 483 participants in The Birkebeiner cross-country ski race (54 km) aged above 65 years were invited to answer a questionnaire. Health status, training history and risk factors for AF were assessed. LAF was defined as AF in absence of established risk factors. Skiers and controls from a Norwegian health survey were only matched for age and gender. Results.– Four hundred and twenty-two (87%) skiers responded. Thirty-two were female. Median age was 67 (range 65–89) years. The overall prevalence of AF was 14% (59/422) in the skiers and 12% (47/398) in the controls (OR [95%CI]: 1,21 [0.81, 1.83], P = 0.41, unadjusted). The prevalence of LAF was 13% and 6% in skiers (43/334) and controls (11/190) respectively (OR [95%CI]: 2.41[1.21, 4.28], P = 0.01). Conclusion.– The prevalence of LAF was significantly higher in old cross-country skiers compared with the general population. The overall prevalence, though, did not differ. Long-term endurance training might have contributed to the higher prevalence of LAF in the skiers. Increased number of participants, inclusion of younger participants and further Assessement of training history will improve the reliability of our results, and validation of the AF diagnosis and higher number of female participants will improve the study quality further. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.021
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Atypical symptoms in elderly patients with peptic ulcers S. Shahla ∗ , E.M. Damsgaard Department Of Geriatrics, Aarhus University Hospital, Aarhus C, Denmark
Introduction.– Background older people seem to experience less pain from a peptic ulcer. The absence of symptoms may be risky as a peptic ulcer may present with severe gastric bleeding. Aim.– To collect evidence for absence of typical symptoms in elderly patients with peptic ulcers. Text.– Method.– We searched in Pub Med, Embase, and Cochrane for the period 1966–2011. MeSH words were: “Peptic ulcer”, “peptic ulcer hemorrhage”, “hematemesis”, “melena’, “pain”, “dyspepsia”, “heartburn”, “asymptomatic”, “signs and symptoms”, “adult” and “geriatrics”. Inclusion: – age 65+; – ulcer confirmed by gastroscopy; – typical symptoms such as epigastric pain relieved by eating or drinking; – atypical symptoms, i.e. absence of pain, other types of abdominal pain, nausea, vomiting, loss of appetite or weight; – Hematemesis, melena. Exclusion: – Cancer; – Hematemesis or melena for other reasons. Results.– Of 3669 titles, 1915 were excluded based on their titles. Next 1640 after reading the abstracts. The full texts of 114 were compared with the inclusion criteria, leaving 17 articles. None of the studies found typical symptoms only, four atypical symptoms, six bleeding, seven atypical symptoms and bleeding. Six were prospective, one prospective and controlled, five retrospective, and five reviews. Conclusion.– It appears that the literature confirms that older patients with peptic ulcer frequently have atypical symptoms, and bleeding may be the first symptom. So further studies should focus on predictors of a bleeding peptic ulcer such as paraclinical observations and the drug list. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.022 P022
Health and disease incidence in Irish, elderly subjects: Baseline findings from the ELDERMET project E.M. O’Connor ∗ , P.W. O’Toole Microbiology, University College Cork, Ireland
Text.– The ELDERMET project is currently studying the interaction between microbiota, diet and health in elderly subjects aged 65+ years. Age-related changes in the composition of the human intestinal microbiota have been linked to adverse health conditions. Therefore, it is important to identify the most prominent chronic medical conditions to provide the evidence-base upon which associations with the microbiota may be explored. Chronic disease/medical condition incidence was examined among 159 community-dwelling subjects. Functional Independence Measure (FIM) and Barthel Index measured functionality. Maximal functional independence was indicated among 90% and 57% of subjects using Barthel Index and FIM, respectively. Chronic cardiovascular conditions were the most prevalent clinical illness among 70% of the cohort, with hypertension and hypercholesterolemia the most common disorders among both genders. Arthritis and osteoporosis were present in 18% and 13% of the cohort, respectively while chronic obstructive pulmonary disease/asthma was reported among 11%. There were no significant differences among genders in
S40
8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S33–S143
the prevalence of chronic conditions with the exception of myocardial infarction, colorectal cancer and benign prostatic hyperplasia, all of which were significantly higher among males (P < 0.05), while the incidence of osteoporosis and thyroid disorders were significantly higher among females (P < 0.05). Anxiety/depression and mood disorders were significantly higher number of females (15%) compared to males (3%) (P = 0.012). Despite good levels of functionality, significant levels of disease and chronic medical conditions prevailed. Identification of associations between the microbiota and chronic disease prevalence could be a potential mechanism to promote healthy aging in elderly populations. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.023 P023
Efficacy role of melaxen in longevity complex therapy of old patients with postinfarctional cardiosclerosis and cardiac failure R. Zaslavskaya ∗ , G. Lilitsa , E. Kalinina Minzdrav, Hospital N 60, Moscow, Russian Federation
Aim.– To determine clinic, anti-ischemic functional effects and influence on oxidative stress of melaxen in old patients (pts) with postinfarction cardiosclerosis (PICS) and heart failure (HF), II-III functional classes (f.c.) on the background of traditional therapy (TT) and the role of melatonin in longevity in these conditions. Patients and method.– Forty-two patients (pts) with PICS and HF II-III f.c. were divided into two randomized groups. The first group received M in a dose of 6 mg once a day at 22:00; the second group 3 mg at the same time. TT included ACE-inhibitors, aspirin, diuretics. Control group (CG) from 21 pts obtained only TT. Day of clinic effect appeared, number and duration episodes of anginal pain, number of ST-depression episodes, episodes of ST-elevation (NEE) by means of ECG-monitoring, variables of EchoCG, BP-monitoring, variables of antioxidant/oxidant defence were registered. Results.– Stable clinic effect appeared on the 4.5 and 5 days in the first and second groups respectively and on the 7 day in CG. Number of EAP in the first group decreased from 3 to 0.3; in the second group – from 4 to 0.2. DAP reduced in the first group from 9.2 to 1.0, in the second group – from 12 to 1 min. Conclusion.– Melaxen in complex therapy of PICS, HF produced antianginal, anti-ischemic, hypotensive effects, improved functional variables and decreased oxidative stress and plays the role in longevity. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.024 P024
NT pro-BNP levels predict 12 months mortality in very elderly individuals following heart failure hospitalisation A. Vilches-Moraga a,∗ , E. Fernandez-Obanza b , R. Menéndez-Colino c , E. Paredes-Galán b , J.L. Gonzalez-Guerrero d , H.J. Solano e , C. Rodriguez-Pascual f a Geriatric Medicine, Complejo Hospitalario Universitario de Vigo, Vigo, Spain b Cardiology, Complejo Hospitalario Univesitario de Vigo, Vigo, Spain c Geriatrics, Hospital Universitario La Paz, Madrid, Spain d Geriatric Medicine, Complejo Hospitalario de Caceres, Caceres, Spain e Geriatric Medicine, Hospital Monte Naranco, Oviedo, Spain f Servicio De Geriatría, Hospital Meixoeiro, Vigo, Spain Objectives.– We aim to determine the association between NT proBNP levels and survival in very elderly patients with significant comorbidity after hospital discharge from any of six Spanish acute
geriatric units (AGU) following treatment of decompensated heart failure (HF). Methods.– HF-Geriatrics is a multicentre randomised trial assessing the effectiveness of a HF disease management programme among geriatric patients with HF and major comorbidity. A total of 336 individuals over 75 years of age underwent NT pro-BNP levels as part of a wider multidisciplinary assessment at the time of admission, on discharge day, at 6 and 12 months. Results.– Mean NT pro-BNP within 24 hours of admission was 7872.26 + 9275 pg/ml (median 4409 pg/ml) whilst on discharge it was 4475 + 5814 pg/ml (median 2501 pg/ml). On univariate analysis, higher levels of NT pro-BNP were significantly associated with increased mortality (P = 0.004 on admission and P = 0.0001 on discharge). Although we did not find a direct relationship between variations in absolute values of NT pro-BNP and mortality, there was an association with neperian or natural logarithm expressed as the inverse function of the exponential function (P < 0.00001). Conclusion.– Higher NT pro-BNP levels at the time of hospital admission and on discharge are directly associated with increased mortality in geriatric patients hospitalised due to decompensated HF. Transformation of NT-proBNP levels into its neperian logarithm improves its predictive capacity and ought to be introduced into everyday clinical practice. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.025 P025
Determination of prognosis in old patients with postinfarctional cardiosclerosis and heart failure in different therapy R. Zaslavskaya ∗ , G. Lilitsa Minzdrav, Hospital N 60, Moscow, Russian Federation
Aim.– To evaluation prognosis in old patients (pts) with postinfarctional (PICS) and cardiac failure (HF)in different kind of therapy. Patients and methods.– Two hundred and sixty pts with PICS and HF, II-III f. c. were divided into 10 randomized groups, depending on using drug. Forty-four pts received eltacin (El) to El–22 pts. Control group of 21 pts obtained traditional therapy (TT) including nitrates, -adrenoblockers, ACE-inhibitors, aspirin, diuretics, calcium antagonists. Twenty-two pts received preductal MB (PMB). Twenty-two pts received El + PMB. Forty-two pts obtained melaxen (Mel) at 22.00 in a dose of 3 mg, 21 pts – emoxipin; 22 pts – selenactiv, and 22 pts – defenced formula twice a day. Twenty-two pts obtained three procedures of plasma separation (PS). All these groups received above-mentioned drugs on the basis of TT during 21 days. By means of ECG-monitoring of Holter, there were examined parameters of cardiac rhythm variability, including mean squared deviation (SDNN); mean deviation of average values in NN–intervals, calculated by 5-minutes intervals during all registration (SDANN). Squared root of sum of differences consistent R-R-intervals (rMSSD), absolute rate of neighbouring intervals, differencing more than 50 mc. Results.– Data received testified to significant dynamics of some indexes under the influence of PS and combination of El + PMB on the basis TT. In these groups, there was registered increase of SDNN and SDANN. Conclusion.– Only plasma separation and combination of El + PMB improved prognosis for old pts with PICS and HF and may be predictors of complications such as fatal arrhythmias and sudden death. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.026
are underprescribed in this indication. We hypothesize that, in patients ≥ 75-years-old, some geriatric characteristics might contribute to the explanation of this underprescription. The objectives were: to study the prevalence of AF in consecutive geriatric patients admitted in an emergency ward and to analyse the barriers to the prescription of anticoagulation therapy. Methods.– Patients ≥ 75 years old admitted in an emergency room of a general hospital were studied between June and December 2011. Medical history, level of indication for treatment with AVK (CHADS2 score), comprehensive geriatric assessment (scales to assess frailty, depression, disability, malnutrition, and comorbidities), and blood analyses were collected prospectively. Results.– One hundred forty two out of 995 patients presented AF (14%). Among patients for whom anticoagulation was indicated (73% of all patients), only 61% were treated. Higher proportions of patients with recent (≤ 6 months) hospitalization, co-medication with digoxine, and taking of greater than three different drugs were observed in the group with anticoagulation therapy than in controls. Conclusions.– Neither the results of the CHADS2 score nor the geriatric characteristics were associated with the decision to administrate or not anticoagulation therapy. More research is needed to identify and clarify the relative importance of patient-, physician- and healthcare system-related barriers to the prescription of AVK therapy in older patients with AF. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.020 P020
Atrial fibrillation in old athletes – the Birkebeiner ageing study M. Myrstad a , A.K. Gulsvik b , A.H. Ranhoff a,∗ Medical Department, Diakonhjemmet Hospital, Oslo, Norway b Medical Department, Oslo University Hospital Ulleval, Oslo, Norway
a
Introduction.– Long-term endurance training seems to predispose to lone atrial fibrillation (LAF) in middle-aged athletes. Our purpose was to explore the prevalence of atrial fibrillation (AF), LAF and risk factors in old cross-country skiers with a history of strenous endurance training, and to compare them with controls from the general population. Methods.– In the pilot-study, 483 participants in The Birkebeiner cross-country ski race (54 km) aged above 65 years were invited to answer a questionnaire. Health status, training history and risk factors for AF were assessed. LAF was defined as AF in absence of established risk factors. Skiers and controls from a Norwegian health survey were only matched for age and gender. Results.– Four hundred and twenty-two (87%) skiers responded. Thirty-two were female. Median age was 67 (range 65–89) years. The overall prevalence of AF was 14% (59/422) in the skiers and 12% (47/398) in the controls (OR [95%CI]: 1,21 [0.81, 1.83], P = 0.41, unadjusted). The prevalence of LAF was 13% and 6% in skiers (43/334) and controls (11/190) respectively (OR [95%CI]: 2.41[1.21, 4.28], P = 0.01). Conclusion.– The prevalence of LAF was significantly higher in old cross-country skiers compared with the general population. The overall prevalence, though, did not differ. Long-term endurance training might have contributed to the higher prevalence of LAF in the skiers. Increased number of participants, inclusion of younger participants and further Assessement of training history will improve the reliability of our results, and validation of the AF diagnosis and higher number of female participants will improve the study quality further. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.021
S39
P021
Atypical symptoms in elderly patients with peptic ulcers S. Shahla ∗ , E.M. Damsgaard Department Of Geriatrics, Aarhus University Hospital, Aarhus C, Denmark
Introduction.– Background older people seem to experience less pain from a peptic ulcer. The absence of symptoms may be risky as a peptic ulcer may present with severe gastric bleeding. Aim.– To collect evidence for absence of typical symptoms in elderly patients with peptic ulcers. Text.– Method.– We searched in Pub Med, Embase, and Cochrane for the period 1966–2011. MeSH words were: “Peptic ulcer”, “peptic ulcer hemorrhage”, “hematemesis”, “melena’, “pain”, “dyspepsia”, “heartburn”, “asymptomatic”, “signs and symptoms”, “adult” and “geriatrics”. Inclusion: – age 65+; – ulcer confirmed by gastroscopy; – typical symptoms such as epigastric pain relieved by eating or drinking; – atypical symptoms, i.e. absence of pain, other types of abdominal pain, nausea, vomiting, loss of appetite or weight; – Hematemesis, melena. Exclusion: – Cancer; – Hematemesis or melena for other reasons. Results.– Of 3669 titles, 1915 were excluded based on their titles. Next 1640 after reading the abstracts. The full texts of 114 were compared with the inclusion criteria, leaving 17 articles. None of the studies found typical symptoms only, four atypical symptoms, six bleeding, seven atypical symptoms and bleeding. Six were prospective, one prospective and controlled, five retrospective, and five reviews. Conclusion.– It appears that the literature confirms that older patients with peptic ulcer frequently have atypical symptoms, and bleeding may be the first symptom. So further studies should focus on predictors of a bleeding peptic ulcer such as paraclinical observations and the drug list. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.022 P022
Health and disease incidence in Irish, elderly subjects: Baseline findings from the ELDERMET project E.M. O’Connor ∗ , P.W. O’Toole Microbiology, University College Cork, Ireland
Text.– The ELDERMET project is currently studying the interaction between microbiota, diet and health in elderly subjects aged 65+ years. Age-related changes in the composition of the human intestinal microbiota have been linked to adverse health conditions. Therefore, it is important to identify the most prominent chronic medical conditions to provide the evidence-base upon which associations with the microbiota may be explored. Chronic disease/medical condition incidence was examined among 159 community-dwelling subjects. Functional Independence Measure (FIM) and Barthel Index measured functionality. Maximal functional independence was indicated among 90% and 57% of subjects using Barthel Index and FIM, respectively. Chronic cardiovascular conditions were the most prevalent clinical illness among 70% of the cohort, with hypertension and hypercholesterolemia the most common disorders among both genders. Arthritis and osteoporosis were present in 18% and 13% of the cohort, respectively while chronic obstructive pulmonary disease/asthma was reported among 11%. There were no significant differences among genders in
S40
8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S33–S143
the prevalence of chronic conditions with the exception of myocardial infarction, colorectal cancer and benign prostatic hyperplasia, all of which were significantly higher among males (P < 0.05), while the incidence of osteoporosis and thyroid disorders were significantly higher among females (P < 0.05). Anxiety/depression and mood disorders were significantly higher number of females (15%) compared to males (3%) (P = 0.012). Despite good levels of functionality, significant levels of disease and chronic medical conditions prevailed. Identification of associations between the microbiota and chronic disease prevalence could be a potential mechanism to promote healthy aging in elderly populations. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.023 P023
Efficacy role of melaxen in longevity complex therapy of old patients with postinfarctional cardiosclerosis and cardiac failure R. Zaslavskaya ∗ , G. Lilitsa , E. Kalinina Minzdrav, Hospital N 60, Moscow, Russian Federation
Aim.– To determine clinic, anti-ischemic functional effects and influence on oxidative stress of melaxen in old patients (pts) with postinfarction cardiosclerosis (PICS) and heart failure (HF), II-III functional classes (f.c.) on the background of traditional therapy (TT) and the role of melatonin in longevity in these conditions. Patients and method.– Forty-two patients (pts) with PICS and HF II-III f.c. were divided into two randomized groups. The first group received M in a dose of 6 mg once a day at 22:00; the second group 3 mg at the same time. TT included ACE-inhibitors, aspirin, diuretics. Control group (CG) from 21 pts obtained only TT. Day of clinic effect appeared, number and duration episodes of anginal pain, number of ST-depression episodes, episodes of ST-elevation (NEE) by means of ECG-monitoring, variables of EchoCG, BP-monitoring, variables of antioxidant/oxidant defence were registered. Results.– Stable clinic effect appeared on the 4.5 and 5 days in the first and second groups respectively and on the 7 day in CG. Number of EAP in the first group decreased from 3 to 0.3; in the second group – from 4 to 0.2. DAP reduced in the first group from 9.2 to 1.0, in the second group – from 12 to 1 min. Conclusion.– Melaxen in complex therapy of PICS, HF produced antianginal, anti-ischemic, hypotensive effects, improved functional variables and decreased oxidative stress and plays the role in longevity. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.024 P024
NT pro-BNP levels predict 12 months mortality in very elderly individuals following heart failure hospitalisation A. Vilches-Moraga a,∗ , E. Fernandez-Obanza b , R. Menéndez-Colino c , E. Paredes-Galán b , J.L. Gonzalez-Guerrero d , H.J. Solano e , C. Rodriguez-Pascual f a Geriatric Medicine, Complejo Hospitalario Universitario de Vigo, Vigo, Spain b Cardiology, Complejo Hospitalario Univesitario de Vigo, Vigo, Spain c Geriatrics, Hospital Universitario La Paz, Madrid, Spain d Geriatric Medicine, Complejo Hospitalario de Caceres, Caceres, Spain e Geriatric Medicine, Hospital Monte Naranco, Oviedo, Spain f Servicio De Geriatría, Hospital Meixoeiro, Vigo, Spain Objectives.– We aim to determine the association between NT proBNP levels and survival in very elderly patients with significant comorbidity after hospital discharge from any of six Spanish acute
geriatric units (AGU) following treatment of decompensated heart failure (HF). Methods.– HF-Geriatrics is a multicentre randomised trial assessing the effectiveness of a HF disease management programme among geriatric patients with HF and major comorbidity. A total of 336 individuals over 75 years of age underwent NT pro-BNP levels as part of a wider multidisciplinary assessment at the time of admission, on discharge day, at 6 and 12 months. Results.– Mean NT pro-BNP within 24 hours of admission was 7872.26 + 9275 pg/ml (median 4409 pg/ml) whilst on discharge it was 4475 + 5814 pg/ml (median 2501 pg/ml). On univariate analysis, higher levels of NT pro-BNP were significantly associated with increased mortality (P = 0.004 on admission and P = 0.0001 on discharge). Although we did not find a direct relationship between variations in absolute values of NT pro-BNP and mortality, there was an association with neperian or natural logarithm expressed as the inverse function of the exponential function (P < 0.00001). Conclusion.– Higher NT pro-BNP levels at the time of hospital admission and on discharge are directly associated with increased mortality in geriatric patients hospitalised due to decompensated HF. Transformation of NT-proBNP levels into its neperian logarithm improves its predictive capacity and ought to be introduced into everyday clinical practice. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.025 P025
Determination of prognosis in old patients with postinfarctional cardiosclerosis and heart failure in different therapy R. Zaslavskaya ∗ , G. Lilitsa Minzdrav, Hospital N 60, Moscow, Russian Federation
Aim.– To evaluation prognosis in old patients (pts) with postinfarctional (PICS) and cardiac failure (HF)in different kind of therapy. Patients and methods.– Two hundred and sixty pts with PICS and HF, II-III f. c. were divided into 10 randomized groups, depending on using drug. Forty-four pts received eltacin (El) to El–22 pts. Control group of 21 pts obtained traditional therapy (TT) including nitrates, -adrenoblockers, ACE-inhibitors, aspirin, diuretics, calcium antagonists. Twenty-two pts received preductal MB (PMB). Twenty-two pts received El + PMB. Forty-two pts obtained melaxen (Mel) at 22.00 in a dose of 3 mg, 21 pts – emoxipin; 22 pts – selenactiv, and 22 pts – defenced formula twice a day. Twenty-two pts obtained three procedures of plasma separation (PS). All these groups received above-mentioned drugs on the basis of TT during 21 days. By means of ECG-monitoring of Holter, there were examined parameters of cardiac rhythm variability, including mean squared deviation (SDNN); mean deviation of average values in NN–intervals, calculated by 5-minutes intervals during all registration (SDANN). Squared root of sum of differences consistent R-R-intervals (rMSSD), absolute rate of neighbouring intervals, differencing more than 50 mc. Results.– Data received testified to significant dynamics of some indexes under the influence of PS and combination of El + PMB on the basis TT. In these groups, there was registered increase of SDNN and SDANN. Conclusion.– Only plasma separation and combination of El + PMB improved prognosis for old pts with PICS and HF and may be predictors of complications such as fatal arrhythmias and sudden death. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.026