I am an American-Turkish Internal medicine consultant physician with special interest in obesity and cardiology. Having previously practiced in 2 continents, I was blown away (literally) by the beauty of Wellington harbour when I came to my first job interview. 3 months later the Morice's arrived to Wellington on the day the"needle" was blown up by lightning. Happy to be practicing medicine in my 3rd continent, the best so far.
Management Of Elderly Patients With NSTEMI At Wellington Regional Hospital: Cardiology Or General Medicine?
Yesim Morice,Wellington Regional Hospital, CCDHB, Wellington, New Zealand
Chris Andersen,Wellington Regional Hospital, CCDHB, Wellington, New Zealand
Radhika Patel, Wellington Regional Hospital, CCDHB, Wellington, New Zealand
Aims: To investigatethe potential differences in evaluations, treatments, comorbidities, and outcomes for patients >75 years with Non ST Elevation Myocardial Infarction (NSTEMI1) managed by Cardiology vs. General Medicine services.
Methods: Retrospective, Electronic Health Record review study of all patients aged ≥75yrs with NSTEMI admitted to General Medicine and Cardiology during a 12-month period (1/11/14 to 30/10/15).
Results: One-hundred patients were evaluated; 59 were admitted to General Medicine and 41 to Cardiology. Compared to Cardiology, those patients admitted to General Medicine were older (86yr vs. 81yr), had higher comorbidities (Charlson index 4.97 vs. 2.68) and had worse levels of cognitive impairment or in-hospital delirium (24% vs. 4%). Patients in General Medicine were also frailer and more likely to be referred to hospice after discharge (17% vs. none), had a higher one-year mortality (53% vs 10%), and were less likely to have angiography (none vs. 66%) or echocardiography (29% vs. 73%). Within General Medicine, individual variations in practice existed regarding dual antiplatelet therapy and anti-coagulation.
Conclusions: In this tertiary referral centre, General Medicine took care of more elderly patients with NSTEMI than Cardiology. Those under General Medicine were older, frailer, and more likely to die within one year. Patients admitted to Cardiology were more likely to have angiography and echocardiography. We believe that while advanced age in itself does not preclude an invasive management approach for NSTEMI, the differences in practice and outcomes observed in this study were the result of appropriate triage strategies based on individualised decisions that considered risk-benefits of treatment, life expectancy, comorbidities, and quality of life.
References: 1Tegn N, et al. Lancet, 12 March 2016; 387- 1057-1065