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P502: Transcatether aortic valve implantation in urgency. A case report from Transcatheter Aortic Valve Implantation Registry with Comprehensive Geriatric Assessment (CGA-TAVI)
Late Breaker Posters / European Geriatric Medicine 5S1 (2014) S235–S253
Conclusions: In our population, more than 80% of patients validated at least 3 criteria of fragility commonly used by different authors. There was a statistically significant relation between different criteria of fragility. Among these criteria, age >75 years, loss of autonomy, polypathology, polymedication were noted in half of patients. The Tunisian old fragile patients are comparable to those described in literature. P500 Horton’s disease after the age of 75 years: about 54 cases A. Laanani, T. Ben Salem, M.E.D. Mejri, I. Ben Ghorbel, M. Khanfir, F. Said, A. Hamzaoui, M. Lamloum, M.H. Houman La Rabta, Tunisia Introduction: Horton’s disease (HD) is a systemic vasculitis affecting large arteries. It occurs almost exclusively in elderly people. Its neurological and ocular manifestations can be confused with complications of atherosclerosis in very elderly patients. Methods: We collected the records of 54 patients aged 75 years and older admitted for MH between 2000 and 2014. The diagnosis was made according to the ACR criteria. Results: There were 54 patients, 25 men and 29 women; the mean age was at 78.4 year (18 patients >80 years). Clinical manifestatioins were: headache (96.2%), intermittent jaw claudication (53.6%), hyperesthesia of the scalp (31.4%) visual disorders (53.6%), state of confusion (10 patients), musculoskeletal manifestations (61%), general symptoms (50%), anomalies of the temporal artery (51 patients). Ocular involvement evocative of HD was found in 37% of cases. Neurological involvement was found in 5 patients: impairment of the sixth cranial nerve (2), the trigeminal (2) and a stroke (1). The biopsy of the temporal artery was performed in 47 of 51 patients. It was abnormal (70%); it showed a typical granuloma (53.1%), atherosclerotic lesions (8.5%), mediocalcosis (4 cases) and arteriolosclerosis (1case). Sedimentation rate was abnormal in 39 cases. All patients were treated with corticosteroids, associated in 84% with aspirin and methotrexate (4 patients). An improvement in the general state and biological parameters were found in all cases. Iatrogenic effects were found in 11 patients. Conclusion: MH in very elderly people is particularly the mode of revelation (confusion) polypathology of the patients and management of complications of corticosteroid therapy. P501 State of health, living conditions and frailty in Tunisian elderly: about 86 patients A. Maoui, M. Lamloum, I. Ben Ghorbel, T. Ben Salem, F. Said, A. Hamzaoui, M. Khanfir, M.H. Houman La Rabta hospital, Tunisia Introduction: Senescence of Tunisian population is in perpetual rise. As a result of increase of life expectancy, frailty of elderly has become one of the major issue of public health for future decades. To warn the occurrence of this phenomenon and thus minimize care expenses, preventive and curative solutions should be proposed. Material and Methods: The present study was carried on elderly persons aged at least 65 years old and admitted to Internal medicine department at La Rabta hospital during a period of 8 years. A geriatric evaluation as well as a frailty scale invalving 10 criteria were used in order to identify weak subjects. The number of three was held back to make the diagnosis. Result: 86 patients were identified. The average age of our patients was about 74.67 years. Evaluating frailty by using an elaborated scale has showed a percentage of 68.6% of patients affected. The most frailty factors described were: impairment of mental ability (dementia/depression) (81.4%), complex therapeutic (58.1%), loss of more than two IADL (58%), female gender (57%) and postural instability (57%). A statistically significant relationship was found between an age exceeding 75 years old, female gendre,
S241
impairment of mental ability and loss of autonomy. Moreover, another statistically significant relationship was noted concerning a pathologic test of “get up and go” (i.e. a risk factor of falling) and postural instability: indeed 62.5% of unstable patients had a pathologic test against only 9.37% for stable. Conclusion: A better knowledge of state of health, living conditions of elderly persons helps to identify the most vulnerable in order to propose new methods of prevention and to improve medical care during hospitalization.
Geriatric cardiology P502 Transcatether aortic valve implantation in urgency. A case report from Transcatheter Aortic Valve Implantation Registry with Comprehensive Geriatric Assessment (CGA-TAVI) G.M. Mannarino, L. Piccioli, S. Baldasseroni, N. Marchionni, M. Stolcova, G. Santoro, A. Ungar AOU Careggi Universit` a degli Studi di Firenze, Firenze, Italy Introduction: CGA-TAVI is an international, multi-center, observational registry. The coprimaries objectives are: to establish predictive value of CGA (with Multidimensional Prognostic IndexMPI, short physical performance battery [SPPB], and SilverCode) for mortality and/or hospitalization; to demonstrate CGA changes within 3 months after TAVI [1–3]. We report the case of one patient enrolled in the CGA-TAVI registry. Methods: A 82-year-old woman had had previous aortic valve replacement. Up to December 2013, she was independent for activity of daily living (BADL preserved 6/6, IADL 6/8) no cognitive impairment. In January 2014 she had heart failure (ejection fraction 35%), degeneration of aortic prosthesis. She underwent to aortic valvuloplasty. In march 2014 the patient had new heart failure. At Echo assessment: degeneration of aortic prosthesis (AV peak 82 mmHg); the Logistic Euroscore II was 43%. The CGA highlighted: short-portable-mental-state-questionnaire (SPMSQ) 4/10 [10], complete dependence for ADL/IADL (preserved 0/6, 0/8); SPPB was 0. Transapical TAVI valve-in-valve with Edwards Sapien-XT-23™ was performed. Ecocardiographic assessment showed prosthesis correctly positioned (AV peak 24 mmHg). Within two months the patient had two hospitalizations for acute renal failure and for COPD. Results: CGA performed after three months showed: SPMSQ 9/10, BADL preserved 4/6, IADL preserved 3/8. SPPB was 7. Conclusions: CGA performed at baseline and at medium term follow-up shows an improvement of health status; SPPB, that is an early predictor of disability and death increased from the baseline [4]. Autonomy level improved even if partially. The results of this case promise well for the final results of CGA-TAVI registry. Reference(s) [1] CGA-TAVI Study Protocol, 2013. [2] Pilotto A, Ferrucci L, Franceschi M, D’Ambrosio LP, Scarcelli C, Cascavilla L, Paris F, Placentino G, Seripa D, Dallapiccola B, Leandro G. Development and validation of a multidimensional prognostic index for one-year mortality from comprehensive geriatric assessment in hospitalized older patients. Rejuvenation Res 2008, 11(1): 151–161. [3] Di Bari M, Balzi D, Roberts AT, Barchielli A, Fumagalli S, Ungar A, Bandinelli S, De Alfieri W, Gabbani L, Marchionni N. Prognostic stratification of older persons based on simple administrative data: development and validation of the ‘Silver Code,’ to be used in emergency department triage. J Gerontol A Biol Sci Med Sci 2010, 65(2): 159–164. [4] Di Bari M, Virgillo A, Matteuzzi D, Inzitari M, Mazzaglia G, Pozzi C, Geppetti P, Masotti G, Marchionni N, Pini R. Predictive validity of measures of comorbidity in older community dwellers: the Insufficienza Cardiaca negli Anziani Residenti a Dicomano Study. J Am Geriatr Soc. 2006 Feb; 54(2): 210–6.
Conclusions: In our population, more than 80% of patients validated at least 3 criteria of fragility commonly used by different authors. There was a statistically significant relation between different criteria of fragility. Among these criteria, age >75 years, loss of autonomy, polypathology, polymedication were noted in half of patients. The Tunisian old fragile patients are comparable to those described in literature. P500 Horton’s disease after the age of 75 years: about 54 cases A. Laanani, T. Ben Salem, M.E.D. Mejri, I. Ben Ghorbel, M. Khanfir, F. Said, A. Hamzaoui, M. Lamloum, M.H. Houman La Rabta, Tunisia Introduction: Horton’s disease (HD) is a systemic vasculitis affecting large arteries. It occurs almost exclusively in elderly people. Its neurological and ocular manifestations can be confused with complications of atherosclerosis in very elderly patients. Methods: We collected the records of 54 patients aged 75 years and older admitted for MH between 2000 and 2014. The diagnosis was made according to the ACR criteria. Results: There were 54 patients, 25 men and 29 women; the mean age was at 78.4 year (18 patients >80 years). Clinical manifestatioins were: headache (96.2%), intermittent jaw claudication (53.6%), hyperesthesia of the scalp (31.4%) visual disorders (53.6%), state of confusion (10 patients), musculoskeletal manifestations (61%), general symptoms (50%), anomalies of the temporal artery (51 patients). Ocular involvement evocative of HD was found in 37% of cases. Neurological involvement was found in 5 patients: impairment of the sixth cranial nerve (2), the trigeminal (2) and a stroke (1). The biopsy of the temporal artery was performed in 47 of 51 patients. It was abnormal (70%); it showed a typical granuloma (53.1%), atherosclerotic lesions (8.5%), mediocalcosis (4 cases) and arteriolosclerosis (1case). Sedimentation rate was abnormal in 39 cases. All patients were treated with corticosteroids, associated in 84% with aspirin and methotrexate (4 patients). An improvement in the general state and biological parameters were found in all cases. Iatrogenic effects were found in 11 patients. Conclusion: MH in very elderly people is particularly the mode of revelation (confusion) polypathology of the patients and management of complications of corticosteroid therapy. P501 State of health, living conditions and frailty in Tunisian elderly: about 86 patients A. Maoui, M. Lamloum, I. Ben Ghorbel, T. Ben Salem, F. Said, A. Hamzaoui, M. Khanfir, M.H. Houman La Rabta hospital, Tunisia Introduction: Senescence of Tunisian population is in perpetual rise. As a result of increase of life expectancy, frailty of elderly has become one of the major issue of public health for future decades. To warn the occurrence of this phenomenon and thus minimize care expenses, preventive and curative solutions should be proposed. Material and Methods: The present study was carried on elderly persons aged at least 65 years old and admitted to Internal medicine department at La Rabta hospital during a period of 8 years. A geriatric evaluation as well as a frailty scale invalving 10 criteria were used in order to identify weak subjects. The number of three was held back to make the diagnosis. Result: 86 patients were identified. The average age of our patients was about 74.67 years. Evaluating frailty by using an elaborated scale has showed a percentage of 68.6% of patients affected. The most frailty factors described were: impairment of mental ability (dementia/depression) (81.4%), complex therapeutic (58.1%), loss of more than two IADL (58%), female gender (57%) and postural instability (57%). A statistically significant relationship was found between an age exceeding 75 years old, female gendre,
S241
impairment of mental ability and loss of autonomy. Moreover, another statistically significant relationship was noted concerning a pathologic test of “get up and go” (i.e. a risk factor of falling) and postural instability: indeed 62.5% of unstable patients had a pathologic test against only 9.37% for stable. Conclusion: A better knowledge of state of health, living conditions of elderly persons helps to identify the most vulnerable in order to propose new methods of prevention and to improve medical care during hospitalization.
Geriatric cardiology P502 Transcatether aortic valve implantation in urgency. A case report from Transcatheter Aortic Valve Implantation Registry with Comprehensive Geriatric Assessment (CGA-TAVI) G.M. Mannarino, L. Piccioli, S. Baldasseroni, N. Marchionni, M. Stolcova, G. Santoro, A. Ungar AOU Careggi Universit` a degli Studi di Firenze, Firenze, Italy Introduction: CGA-TAVI is an international, multi-center, observational registry. The coprimaries objectives are: to establish predictive value of CGA (with Multidimensional Prognostic IndexMPI, short physical performance battery [SPPB], and SilverCode) for mortality and/or hospitalization; to demonstrate CGA changes within 3 months after TAVI [1–3]. We report the case of one patient enrolled in the CGA-TAVI registry. Methods: A 82-year-old woman had had previous aortic valve replacement. Up to December 2013, she was independent for activity of daily living (BADL preserved 6/6, IADL 6/8) no cognitive impairment. In January 2014 she had heart failure (ejection fraction 35%), degeneration of aortic prosthesis. She underwent to aortic valvuloplasty. In march 2014 the patient had new heart failure. At Echo assessment: degeneration of aortic prosthesis (AV peak 82 mmHg); the Logistic Euroscore II was 43%. The CGA highlighted: short-portable-mental-state-questionnaire (SPMSQ) 4/10 [10], complete dependence for ADL/IADL (preserved 0/6, 0/8); SPPB was 0. Transapical TAVI valve-in-valve with Edwards Sapien-XT-23™ was performed. Ecocardiographic assessment showed prosthesis correctly positioned (AV peak 24 mmHg). Within two months the patient had two hospitalizations for acute renal failure and for COPD. Results: CGA performed after three months showed: SPMSQ 9/10, BADL preserved 4/6, IADL preserved 3/8. SPPB was 7. Conclusions: CGA performed at baseline and at medium term follow-up shows an improvement of health status; SPPB, that is an early predictor of disability and death increased from the baseline [4]. Autonomy level improved even if partially. The results of this case promise well for the final results of CGA-TAVI registry. Reference(s) [1] CGA-TAVI Study Protocol, 2013. [2] Pilotto A, Ferrucci L, Franceschi M, D’Ambrosio LP, Scarcelli C, Cascavilla L, Paris F, Placentino G, Seripa D, Dallapiccola B, Leandro G. Development and validation of a multidimensional prognostic index for one-year mortality from comprehensive geriatric assessment in hospitalized older patients. Rejuvenation Res 2008, 11(1): 151–161. [3] Di Bari M, Balzi D, Roberts AT, Barchielli A, Fumagalli S, Ungar A, Bandinelli S, De Alfieri W, Gabbani L, Marchionni N. Prognostic stratification of older persons based on simple administrative data: development and validation of the ‘Silver Code,’ to be used in emergency department triage. J Gerontol A Biol Sci Med Sci 2010, 65(2): 159–164. [4] Di Bari M, Virgillo A, Matteuzzi D, Inzitari M, Mazzaglia G, Pozzi C, Geppetti P, Masotti G, Marchionni N, Pini R. Predictive validity of measures of comorbidity in older community dwellers: the Insufficienza Cardiaca negli Anziani Residenti a Dicomano Study. J Am Geriatr Soc. 2006 Feb; 54(2): 210–6.