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P157: Renal sympathetic denervation could reduce polypharmacy in elderly patients with resistant hypertension
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Poster presentations, Thursday 18 September 2014 / European Geriatric Medicine 5S1 (2014) S83–S158
P154 Microvascular ischemia or cardiovascular syndrome x in the elderly. Acute geriatric unit, Chilean Air Force Hospital T.L. Quiroz, A. Brizzolara, R. Alvarado, M.E. Linfati, E. Araya Hospital fach, Santiago, Chile Microvascular ischemia or cardiovascular syndrome x (CSX) is a pathological entity with atypical angina, enzymatic elevation, positive cardiac ischemic test and non stenotic coronary angiography. Regarding physiopathological basis, metabolic and haemorheological environment include hyperinsulinemia, systemic inflammation and procoagulant state. Most of them are perimenopausal females and medium age males but literature is scanty in elderly subjects. Methods, Case summary: We admitted in our geriatric inpatient ward an 87 years male with history of hypertension, dyslipidemia, atrial fibrillation, previous ischemic stroke without sequelae and metabolic syndrome. Actual therapy Acenocumarol, Metformin. Patient is independent in ADL and IADL, without cognitive impairment. He had prior history of typical angina, since 1997, with echocardiography/dipyridamole with apical ischemia; normal coronary angiography (1997). In January 2014 he came to the emergency unit presenting dizziness, lipotimia, precordial pain and diaphoresis. In our unit electrocardiogram (EKG) was dubious negative (RBB), mild troponines elevation (0.023; normal <0.014); nitroglycerine infusion control precordial pain. Results: Because of typical angina associated with dubious EKG and enzymes a new coronary angiography was realized during hospitalization, with normal result. The patient was pre-fragile, presenting slow walking speed (17 seconds in 4.5 meters) and had self-reported exhaustion, with normal grip strength (90th percentile). He had hyperinsulinemia (fast insulinaemia: 21.4 uUl/mL; 2 hours pp: 83.9 uUl/ml (normal <75 uUl/mL); altered homeostasis Model Assessment: 5.12 (normal: 0.4–3.7) and obesity (BMI: 33.59 kg/m2 ; waist circumference: 105 cm, associated with higher cardiometabolic risk). We optimized the therapy of angina and anticoagulant. Conclusions: We present an elderly case of microvascular ischemia, with history of typical angina with serial non stenotic coronary angiography. We propose this syndrome as a condition of prefragility where many mechanisms as metabolic environment, hyperinsulinemia and systemic inflammation participated. The suspect must be in this groups of patient with risk factor, avoiding repeated invasive exams as coronary angiography and consecuent iatrogenia that is a real risk for the elderly. P155 Upper and lower limb muscles strength in elderly patients with heart failure E.M. Esmayel, H.M. Hassanin, N.M. Rashad, A.A. Mahmood, M.A. Abdou Zagazig University, Faculty of Medicine, Zagazig, Egypt Introduction: Many elderly with heart failure (HF) report greater impairment in skeletal muscle functions. Methods: This cross sectional study aimed at determination of handgrip strength (HGS) in kg of both hands in 32 elderly (≥65 years old) patients with clinically stable HF using hand held mechanical dynamometer, as a measure of upper limb muscles strength. The lower limb muscles strength was assessed by counting the repetitions (rep.) of stand and sit on a chair during 30 seconds [the 30 seconds chair-stand test (CST)]. Heart failure was diagnosed clinically as well as by echocardiography. The New York Heart Association (NYHA) functional classification of HF patients was used to obtain two groups of patients; NYHA class II (14 patients), and NYHA class III (18 patients). The study included also 12 healthy elderly, matched to HF patients as regard age, gender, occupation and body built, as control.
Results: Showed statistically significant decrease in both HGS and CST score in all HF patients (9.7±4 kg, 8.8±3 rep., respectively) compared to controls (77.8±11 kg, 13.5±1 rep., respectively, p < 0.001). Patients with severe HF (class III patients) had the more significant decline (6.2±3 kg, 6.8±2 rep., respectively) compared to both controls (p < 0.001) and class II patients (15±6 kg, 11±2 rep., respectively, p < 0.01), with significant difference noticed also between the latter two groups (p < 0.001). Both HGS and CST scores correlated significantly negatively with NYHA class (p < 0.001), and significantly positively with left ventricular ejection fraction (p < 0.002). Conclusions: Strength of upper and lower limb muscles may reflect clinical severity of HF in elderly patient, and its measurement may be of prognostic value. P156 Effects of liraglutide on cardiovascular markers in obese old patients with type 2 diabetes: a pre–post clinical trial S. Perna1 , D. Guido2 , P. Astrone3 , F. Guerriero1 , C. Sgarlata2 , M. Rollone3 , A. Grugnetti2 , M. Rondanelli1 , S.B. Solerte1 1 University of Pavia, Azienda di Servizi alla Persona of Pavia, Pavia, Italy; 2 University of Pavia, Pavia, Italy; 3 Azienda di Servizi alla Persona of Pavia, Pavia, Italy Introduction: Our aim was to assess the effects of liraglutide on cardiovascular markers in obese old patients with type 2 diabetes. Material and Methods: A pre–post clinical trial was performed in 28 diabetic old subjects (females/males 12/16; age 74.8±9.3; BMI= 33.8±5.6 kg/m2 ). Data from cardiovascular parameters such as triglycerides (172±94), cholesterol (202±44), HDL (46±14), LDL (121±35), PAS (143±23), and PAD (85±9.3) have been collected at baseline (t0) and after the 6-months treatment (t1 ). Subjects were enrolled to receive liraglutide (at doses up to 3.0 mg per day). Statistical analysis was performed using paired two tail t-tests for repeated measures to assess the mean differences of cardiovascular parameters (post-pre treatment). Results: Only cholesterol showed a significant decrease of 39.5 mg/dl (P = 0.006). Triglycerides and PAS returned suggestive evidences, −62 mg/dl (P = 0.057), and −7.85 mmHg (P = 0.097), respectively. No other parameters returned relevant evidences (P > 0.10). Conclusions: Our findings show that liraglutide is a potential therapy in the treatment of cardiovascular risk factors and it may be safely used in old patients with metabolic syndrome. P157 Renal sympathetic denervation could reduce polypharmacy in elderly patients with resistant hypertension A. Matejkova1 , J. Matejka2 , M. Kubrycht1 , V. Novotny2 , T. Lazarak2 , V. Rozsival2 , I. Varvarovsky2 1 Regional Hospital Pardubice and University of Pardubice, Pardubice, Czech Republic; 2 Cardiology Center AGEL and Department of Cardiology, Regional Hospital Pardubice, Pardubice, Czech Republic Introduction: Renal sympathetic denervation (RDN) represents a novel method in treatment-resistant hypertension management. Aim of our study was to describe response to RDN in elderly patients in regard of polypharmacy reduction. Methods: We performed prospective analysis of patients who underwent renal sympathetic denervation from March 2012 to December 2013. Results: RDN was performed in 21 patients using Symplicity system. 11 of them were older than 60 years and were included in our analysis. Average age of the patients was 69 years (median 68), body mass index 30.3±2.7, baseline estimated glomerular filtration rate 1.28±0.38 ml/s/1.73 m2, casual blood pressure 168±15/86±12 mmHg and ambulatory blood pressure 155±14/76±12 mmHg. Our sample included 64% of diabetics.
Poster presentations, Thursday 18 September 2014 / European Geriatric Medicine 5S1 (2014) S83–S158
Patients were taking 3–7 (median 5) classes of antihypertensives including diuretics. Periprocedural complications included 2 cases of transient hypotension. No renal artery damage, worsening renal function or vascular complications occurred during procedure or follow up. 3 months after the procedure average casual blood pressure decrease was 17/3 mmHg, average ambulatory blood pressure decrease was 2/6 mmHg. Decrease in number of antihypertensive medications was possible in 5 (46%) patients. Conclusions: Authors present real life experience with RDN in treatment-resistant hypertension management in the elderly. At 3 months after the procedure significant reduction of casual blood pressure was achieved. RDN enabled us to decrease number of antihypertensive drugs in nearly one half of the patients. P158 Heart failure in oldest: clinical profile and heatlh education L. Guardado, I. Carmona, F.J. Martin Sanchez, V. Salido, P. Gil Gregorio Hospital Clinico San Carlos, Spain Heart failure is listed as one of the leading causes of admissions and readmission in the elderly. Comorbidity and quality of life are associated elements that can modify the natural history of this entity. Aim: Describing the clinical features, comorbidity and information of the heart failure among elderly population in a Geriatric Acute Unit. Methodology: A prospective and descriptive study of patients over 75 years old with heart failure as the principal reason for hospitalization. Collection and follow up period of a year. The following variables were collected: Age, gender, etiopathogeny, comorbidity using Charlson index modified by age, echocardiogram transthoracic, functional assessment, social resources using OARS scale, level of knowledge by the Dewalt test and health knowledge by de SAHLSA scale. Results: Sample size: 105 patients. Middle age 87.8±5.9. Women: 72.3%. Charlson index modified by age: 9.5±3.9. Hypertension: 85%, Atrial fibrillation: 54%, Diabetes Mellitus type 2: 34.7%. Echocardiographic data: systole dysfunction 27.4%. OARS scale: Good–excellent social resources: 85.5%. Level of Knowledge (SAHLSA scale) 6.3 (maximum 15). Readmision patients after discharge: 20% (one year). Conclusions: 1. Systolic dysfunction as a tipology of heart failure in the elderly less frequent that younger patients. 2. High level of comorbidity, mainly hypertension and atrial fibrillation. 3. High percentage of readmission by the same pathology. 4. Low level of knowledge of this entity which support the need of health education in these patients. This work was supported by the Instituto de Salud Carlos III, through PI09/91116 project cofunded by the European Development Fund. P159 New method of assessment of reflected waves with MRI during aging L.I. Joly1 , D. Mandry1 , P.Y. Marie1 , A. Benetos1 , G. Hossu2 , K. Kourtiche2 , M.D. Diallo2 , G. Karcher1 1 CHU Nancy, Vandoeuvre-l`es-Nancy, France; 2 Lorraine University, Nancy, France Introduction: Aortic pulse wave velocity, pulse pressure amplification which depends on the central aortic pressure waveform are significant cardiovascular risk markers. They depend closely on the structural and functional properties of elastic central and
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peripheral muscular arteries. The central pressure waveform can be decomposed into pressure wave transmission and reflection. Methods: This study proposes a novel method using wave intensity analysis to assess reflected waves by decomposition of magnetic resonance imaging central aortic flow and central aortic pressure waveform measured by tonometry in four patients of young, middle, old and old old ages. Aortic flow was measured at the level of ascending aorta by magnetic resonance imaging (MRI) and pressure waveform with tonometry at the carotid level. Results: A graphical user interfaces (GUIs) was programmed and methods for automatic signal treatments under Matlab platform was developed to allow us to identify the involvement of reflection waves in the pressure signal and to provide useful clues to the characterization of the arterial system to understand cardiovascular diseases for better prospects and better healthcare plan. Conclusions: This automatical signal treatment of aortic flow and pulse pressure waveform is a good method for assessment of wave reflections in young and older subjects allowing to obtain reflection magnitude. This new tool will be used to assess reflection waves in older subjects in pathological situation such as hypertension.
Figure: Incident and reflected waves measures by wave intensity analysis in four subjects: a young subject of 20 years, a middle-aged and two old subjects.
P160 Heart failure in nonagenarian population A.C. Perez ´ Rodr´ıguez, T.I. Wu, J. Marttini Abarca, F.J. Martin Sanchez, P. Gil Gregorio Hospital Cl´ınico San Carlos, Spain Objectives: To study the differences in comorbidity in the nonagenarian population with acute heart failure who were hospitalized against the younger elder population. Method: This is a descriptive transversal study about patients with heart failure. Data collection was done utilizing the discharge summary of patients who were discharged with the diagnostic of Heart Failure (according to Framingham clinical criteria) from January of 2012 till December of 2013. This study included 315 patients, who were discharged from the Hospitalization Unit of the Geriatrics Department. The sample was divided into two groups: one group comprised with patients <90 years old (148 patients) and the other group was of patients ≥90 years old (167 patients). The following variables were collected: Age, gender, underlying diseases, NYHA scale, prescribed medication, cause of hospitalization, cardiac function measured through transthoracic echocardiogram and death during hospitalization. The statistical analysis of this study was done using the SPSS software version 15.0. Results: Results are described in Table 1. There was no compelling difference in the rest of the variables analyzed. Conclusions: 1. The nonagenarian population does not seem to present more functional or cognitive decline than the younger elder population. 2. The nonagenarian population has a lower NYHA stage and less prevalence of COPD.
Poster presentations, Thursday 18 September 2014 / European Geriatric Medicine 5S1 (2014) S83–S158
P154 Microvascular ischemia or cardiovascular syndrome x in the elderly. Acute geriatric unit, Chilean Air Force Hospital T.L. Quiroz, A. Brizzolara, R. Alvarado, M.E. Linfati, E. Araya Hospital fach, Santiago, Chile Microvascular ischemia or cardiovascular syndrome x (CSX) is a pathological entity with atypical angina, enzymatic elevation, positive cardiac ischemic test and non stenotic coronary angiography. Regarding physiopathological basis, metabolic and haemorheological environment include hyperinsulinemia, systemic inflammation and procoagulant state. Most of them are perimenopausal females and medium age males but literature is scanty in elderly subjects. Methods, Case summary: We admitted in our geriatric inpatient ward an 87 years male with history of hypertension, dyslipidemia, atrial fibrillation, previous ischemic stroke without sequelae and metabolic syndrome. Actual therapy Acenocumarol, Metformin. Patient is independent in ADL and IADL, without cognitive impairment. He had prior history of typical angina, since 1997, with echocardiography/dipyridamole with apical ischemia; normal coronary angiography (1997). In January 2014 he came to the emergency unit presenting dizziness, lipotimia, precordial pain and diaphoresis. In our unit electrocardiogram (EKG) was dubious negative (RBB), mild troponines elevation (0.023; normal <0.014); nitroglycerine infusion control precordial pain. Results: Because of typical angina associated with dubious EKG and enzymes a new coronary angiography was realized during hospitalization, with normal result. The patient was pre-fragile, presenting slow walking speed (17 seconds in 4.5 meters) and had self-reported exhaustion, with normal grip strength (90th percentile). He had hyperinsulinemia (fast insulinaemia: 21.4 uUl/mL; 2 hours pp: 83.9 uUl/ml (normal <75 uUl/mL); altered homeostasis Model Assessment: 5.12 (normal: 0.4–3.7) and obesity (BMI: 33.59 kg/m2 ; waist circumference: 105 cm, associated with higher cardiometabolic risk). We optimized the therapy of angina and anticoagulant. Conclusions: We present an elderly case of microvascular ischemia, with history of typical angina with serial non stenotic coronary angiography. We propose this syndrome as a condition of prefragility where many mechanisms as metabolic environment, hyperinsulinemia and systemic inflammation participated. The suspect must be in this groups of patient with risk factor, avoiding repeated invasive exams as coronary angiography and consecuent iatrogenia that is a real risk for the elderly. P155 Upper and lower limb muscles strength in elderly patients with heart failure E.M. Esmayel, H.M. Hassanin, N.M. Rashad, A.A. Mahmood, M.A. Abdou Zagazig University, Faculty of Medicine, Zagazig, Egypt Introduction: Many elderly with heart failure (HF) report greater impairment in skeletal muscle functions. Methods: This cross sectional study aimed at determination of handgrip strength (HGS) in kg of both hands in 32 elderly (≥65 years old) patients with clinically stable HF using hand held mechanical dynamometer, as a measure of upper limb muscles strength. The lower limb muscles strength was assessed by counting the repetitions (rep.) of stand and sit on a chair during 30 seconds [the 30 seconds chair-stand test (CST)]. Heart failure was diagnosed clinically as well as by echocardiography. The New York Heart Association (NYHA) functional classification of HF patients was used to obtain two groups of patients; NYHA class II (14 patients), and NYHA class III (18 patients). The study included also 12 healthy elderly, matched to HF patients as regard age, gender, occupation and body built, as control.
Results: Showed statistically significant decrease in both HGS and CST score in all HF patients (9.7±4 kg, 8.8±3 rep., respectively) compared to controls (77.8±11 kg, 13.5±1 rep., respectively, p < 0.001). Patients with severe HF (class III patients) had the more significant decline (6.2±3 kg, 6.8±2 rep., respectively) compared to both controls (p < 0.001) and class II patients (15±6 kg, 11±2 rep., respectively, p < 0.01), with significant difference noticed also between the latter two groups (p < 0.001). Both HGS and CST scores correlated significantly negatively with NYHA class (p < 0.001), and significantly positively with left ventricular ejection fraction (p < 0.002). Conclusions: Strength of upper and lower limb muscles may reflect clinical severity of HF in elderly patient, and its measurement may be of prognostic value. P156 Effects of liraglutide on cardiovascular markers in obese old patients with type 2 diabetes: a pre–post clinical trial S. Perna1 , D. Guido2 , P. Astrone3 , F. Guerriero1 , C. Sgarlata2 , M. Rollone3 , A. Grugnetti2 , M. Rondanelli1 , S.B. Solerte1 1 University of Pavia, Azienda di Servizi alla Persona of Pavia, Pavia, Italy; 2 University of Pavia, Pavia, Italy; 3 Azienda di Servizi alla Persona of Pavia, Pavia, Italy Introduction: Our aim was to assess the effects of liraglutide on cardiovascular markers in obese old patients with type 2 diabetes. Material and Methods: A pre–post clinical trial was performed in 28 diabetic old subjects (females/males 12/16; age 74.8±9.3; BMI= 33.8±5.6 kg/m2 ). Data from cardiovascular parameters such as triglycerides (172±94), cholesterol (202±44), HDL (46±14), LDL (121±35), PAS (143±23), and PAD (85±9.3) have been collected at baseline (t0) and after the 6-months treatment (t1 ). Subjects were enrolled to receive liraglutide (at doses up to 3.0 mg per day). Statistical analysis was performed using paired two tail t-tests for repeated measures to assess the mean differences of cardiovascular parameters (post-pre treatment). Results: Only cholesterol showed a significant decrease of 39.5 mg/dl (P = 0.006). Triglycerides and PAS returned suggestive evidences, −62 mg/dl (P = 0.057), and −7.85 mmHg (P = 0.097), respectively. No other parameters returned relevant evidences (P > 0.10). Conclusions: Our findings show that liraglutide is a potential therapy in the treatment of cardiovascular risk factors and it may be safely used in old patients with metabolic syndrome. P157 Renal sympathetic denervation could reduce polypharmacy in elderly patients with resistant hypertension A. Matejkova1 , J. Matejka2 , M. Kubrycht1 , V. Novotny2 , T. Lazarak2 , V. Rozsival2 , I. Varvarovsky2 1 Regional Hospital Pardubice and University of Pardubice, Pardubice, Czech Republic; 2 Cardiology Center AGEL and Department of Cardiology, Regional Hospital Pardubice, Pardubice, Czech Republic Introduction: Renal sympathetic denervation (RDN) represents a novel method in treatment-resistant hypertension management. Aim of our study was to describe response to RDN in elderly patients in regard of polypharmacy reduction. Methods: We performed prospective analysis of patients who underwent renal sympathetic denervation from March 2012 to December 2013. Results: RDN was performed in 21 patients using Symplicity system. 11 of them were older than 60 years and were included in our analysis. Average age of the patients was 69 years (median 68), body mass index 30.3±2.7, baseline estimated glomerular filtration rate 1.28±0.38 ml/s/1.73 m2, casual blood pressure 168±15/86±12 mmHg and ambulatory blood pressure 155±14/76±12 mmHg. Our sample included 64% of diabetics.
Poster presentations, Thursday 18 September 2014 / European Geriatric Medicine 5S1 (2014) S83–S158
Patients were taking 3–7 (median 5) classes of antihypertensives including diuretics. Periprocedural complications included 2 cases of transient hypotension. No renal artery damage, worsening renal function or vascular complications occurred during procedure or follow up. 3 months after the procedure average casual blood pressure decrease was 17/3 mmHg, average ambulatory blood pressure decrease was 2/6 mmHg. Decrease in number of antihypertensive medications was possible in 5 (46%) patients. Conclusions: Authors present real life experience with RDN in treatment-resistant hypertension management in the elderly. At 3 months after the procedure significant reduction of casual blood pressure was achieved. RDN enabled us to decrease number of antihypertensive drugs in nearly one half of the patients. P158 Heart failure in oldest: clinical profile and heatlh education L. Guardado, I. Carmona, F.J. Martin Sanchez, V. Salido, P. Gil Gregorio Hospital Clinico San Carlos, Spain Heart failure is listed as one of the leading causes of admissions and readmission in the elderly. Comorbidity and quality of life are associated elements that can modify the natural history of this entity. Aim: Describing the clinical features, comorbidity and information of the heart failure among elderly population in a Geriatric Acute Unit. Methodology: A prospective and descriptive study of patients over 75 years old with heart failure as the principal reason for hospitalization. Collection and follow up period of a year. The following variables were collected: Age, gender, etiopathogeny, comorbidity using Charlson index modified by age, echocardiogram transthoracic, functional assessment, social resources using OARS scale, level of knowledge by the Dewalt test and health knowledge by de SAHLSA scale. Results: Sample size: 105 patients. Middle age 87.8±5.9. Women: 72.3%. Charlson index modified by age: 9.5±3.9. Hypertension: 85%, Atrial fibrillation: 54%, Diabetes Mellitus type 2: 34.7%. Echocardiographic data: systole dysfunction 27.4%. OARS scale: Good–excellent social resources: 85.5%. Level of Knowledge (SAHLSA scale) 6.3 (maximum 15). Readmision patients after discharge: 20% (one year). Conclusions: 1. Systolic dysfunction as a tipology of heart failure in the elderly less frequent that younger patients. 2. High level of comorbidity, mainly hypertension and atrial fibrillation. 3. High percentage of readmission by the same pathology. 4. Low level of knowledge of this entity which support the need of health education in these patients. This work was supported by the Instituto de Salud Carlos III, through PI09/91116 project cofunded by the European Development Fund. P159 New method of assessment of reflected waves with MRI during aging L.I. Joly1 , D. Mandry1 , P.Y. Marie1 , A. Benetos1 , G. Hossu2 , K. Kourtiche2 , M.D. Diallo2 , G. Karcher1 1 CHU Nancy, Vandoeuvre-l`es-Nancy, France; 2 Lorraine University, Nancy, France Introduction: Aortic pulse wave velocity, pulse pressure amplification which depends on the central aortic pressure waveform are significant cardiovascular risk markers. They depend closely on the structural and functional properties of elastic central and
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peripheral muscular arteries. The central pressure waveform can be decomposed into pressure wave transmission and reflection. Methods: This study proposes a novel method using wave intensity analysis to assess reflected waves by decomposition of magnetic resonance imaging central aortic flow and central aortic pressure waveform measured by tonometry in four patients of young, middle, old and old old ages. Aortic flow was measured at the level of ascending aorta by magnetic resonance imaging (MRI) and pressure waveform with tonometry at the carotid level. Results: A graphical user interfaces (GUIs) was programmed and methods for automatic signal treatments under Matlab platform was developed to allow us to identify the involvement of reflection waves in the pressure signal and to provide useful clues to the characterization of the arterial system to understand cardiovascular diseases for better prospects and better healthcare plan. Conclusions: This automatical signal treatment of aortic flow and pulse pressure waveform is a good method for assessment of wave reflections in young and older subjects allowing to obtain reflection magnitude. This new tool will be used to assess reflection waves in older subjects in pathological situation such as hypertension.
Figure: Incident and reflected waves measures by wave intensity analysis in four subjects: a young subject of 20 years, a middle-aged and two old subjects.
P160 Heart failure in nonagenarian population A.C. Perez ´ Rodr´ıguez, T.I. Wu, J. Marttini Abarca, F.J. Martin Sanchez, P. Gil Gregorio Hospital Cl´ınico San Carlos, Spain Objectives: To study the differences in comorbidity in the nonagenarian population with acute heart failure who were hospitalized against the younger elder population. Method: This is a descriptive transversal study about patients with heart failure. Data collection was done utilizing the discharge summary of patients who were discharged with the diagnostic of Heart Failure (according to Framingham clinical criteria) from January of 2012 till December of 2013. This study included 315 patients, who were discharged from the Hospitalization Unit of the Geriatrics Department. The sample was divided into two groups: one group comprised with patients <90 years old (148 patients) and the other group was of patients ≥90 years old (167 patients). The following variables were collected: Age, gender, underlying diseases, NYHA scale, prescribed medication, cause of hospitalization, cardiac function measured through transthoracic echocardiogram and death during hospitalization. The statistical analysis of this study was done using the SPSS software version 15.0. Results: Results are described in Table 1. There was no compelling difference in the rest of the variables analyzed. Conclusions: 1. The nonagenarian population does not seem to present more functional or cognitive decline than the younger elder population. 2. The nonagenarian population has a lower NYHA stage and less prevalence of COPD.