The relationship between Elder Risk Assessment (ERA) scores and cardiac revascularization: A cohort study in Olmsted County, Minnesota, USA

Saurabh Sharma, Shruti Datta, Shahyar Gharacholou, Shahzad K. Siddique, Stephen S. Cha, Paul Y Takahashi

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: The aging population is predisposed to cardiovascular disease. Our goal was to determine the relationship between a higher Elder Risk Assessment (ERA) score and coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), in adults over 60 years. Methods: This was a retrospective cohort study in a primary care internal medicine practice. Patients included community-dwelling individuals aged 60 years or older on January 1, 2005. The primary outcome was a combined outcome of CABG and PCI in 2 years. The secondary outcome was mortality 5 years after CABG or PCI. The primary predictor variable was the score on the ERA Index, an instrument that predicts emergency room visits and hospitalization. The outcomes were obtained using administrative data from electronic medical records. The analysis included logistic regression, with odds ratios for the primary outcome and time-to-event analysis for mortality. Results: The records of 12,650 patients were studied. A total of 902 patients (7.1%) had either CABG or PCI, with an average age of 74.5 years (±8.3 years). There were 205 patients (23%) who experienced CABG or PCI in the highest-score group (top 10%) compared with 29 patients (3%) in the lowest score group, for an odds ratio of 15.4; 95% confidence interval, 10.1-23.5. There was a greater association of revascularization events by increasing score group. We noted increased mortality by increasing ERA score, in patients undergoing CABG or PCI. The patients in the highest-scoring group had a 50% 5-year survival rate compared with a 97% 5-year survival rate in the lowest-scoring group (P < 0.001). Conclusion: Older adults in the highest-ERA-scoring group had the highest utilization of CABG or PCI. Patients with high ERA scores undergoing coronary revascularization were also at the highest risk of mortality. Providers should be aware that higher ERA scores can potentially predict outcomes in high-risk patients.

Original languageEnglish (US)
Pages (from-to)1209-1215
Number of pages7
JournalClinical Interventions in Aging
Volume8
DOIs
StatePublished - Sep 13 2013

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Percutaneous Coronary Intervention
Cohort Studies
Coronary Artery Bypass
Transplants
Mortality
Survival Rate
Odds Ratio
Independent Living
Electronic Health Records
Internal Medicine
Hospital Emergency Service
Primary Health Care
Hospitalization
Cardiovascular Diseases
Retrospective Studies
Logistic Models
Confidence Intervals
Population

Keywords

  • Coronary bypass
  • Geriatrics
  • Mortality
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

The relationship between Elder Risk Assessment (ERA) scores and cardiac revascularization : A cohort study in Olmsted County, Minnesota, USA. / Sharma, Saurabh; Datta, Shruti; Gharacholou, Shahyar; Siddique, Shahzad K.; Cha, Stephen S.; Takahashi, Paul Y.

In: Clinical Interventions in Aging, Vol. 8, 13.09.2013, p. 1209-1215.

Research output: Contribution to journalArticle

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abstract = "Purpose: The aging population is predisposed to cardiovascular disease. Our goal was to determine the relationship between a higher Elder Risk Assessment (ERA) score and coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), in adults over 60 years. Methods: This was a retrospective cohort study in a primary care internal medicine practice. Patients included community-dwelling individuals aged 60 years or older on January 1, 2005. The primary outcome was a combined outcome of CABG and PCI in 2 years. The secondary outcome was mortality 5 years after CABG or PCI. The primary predictor variable was the score on the ERA Index, an instrument that predicts emergency room visits and hospitalization. The outcomes were obtained using administrative data from electronic medical records. The analysis included logistic regression, with odds ratios for the primary outcome and time-to-event analysis for mortality. Results: The records of 12,650 patients were studied. A total of 902 patients (7.1{\%}) had either CABG or PCI, with an average age of 74.5 years (±8.3 years). There were 205 patients (23{\%}) who experienced CABG or PCI in the highest-score group (top 10{\%}) compared with 29 patients (3{\%}) in the lowest score group, for an odds ratio of 15.4; 95{\%} confidence interval, 10.1-23.5. There was a greater association of revascularization events by increasing score group. We noted increased mortality by increasing ERA score, in patients undergoing CABG or PCI. The patients in the highest-scoring group had a 50{\%} 5-year survival rate compared with a 97{\%} 5-year survival rate in the lowest-scoring group (P < 0.001). Conclusion: Older adults in the highest-ERA-scoring group had the highest utilization of CABG or PCI. Patients with high ERA scores undergoing coronary revascularization were also at the highest risk of mortality. Providers should be aware that higher ERA scores can potentially predict outcomes in high-risk patients.",
keywords = "Coronary bypass, Geriatrics, Mortality, Percutaneous coronary intervention",
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AU - Gharacholou, Shahyar

AU - Siddique, Shahzad K.

AU - Cha, Stephen S.

AU - Takahashi, Paul Y

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AB - Purpose: The aging population is predisposed to cardiovascular disease. Our goal was to determine the relationship between a higher Elder Risk Assessment (ERA) score and coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), in adults over 60 years. Methods: This was a retrospective cohort study in a primary care internal medicine practice. Patients included community-dwelling individuals aged 60 years or older on January 1, 2005. The primary outcome was a combined outcome of CABG and PCI in 2 years. The secondary outcome was mortality 5 years after CABG or PCI. The primary predictor variable was the score on the ERA Index, an instrument that predicts emergency room visits and hospitalization. The outcomes were obtained using administrative data from electronic medical records. The analysis included logistic regression, with odds ratios for the primary outcome and time-to-event analysis for mortality. Results: The records of 12,650 patients were studied. A total of 902 patients (7.1%) had either CABG or PCI, with an average age of 74.5 years (±8.3 years). There were 205 patients (23%) who experienced CABG or PCI in the highest-score group (top 10%) compared with 29 patients (3%) in the lowest score group, for an odds ratio of 15.4; 95% confidence interval, 10.1-23.5. There was a greater association of revascularization events by increasing score group. We noted increased mortality by increasing ERA score, in patients undergoing CABG or PCI. The patients in the highest-scoring group had a 50% 5-year survival rate compared with a 97% 5-year survival rate in the lowest-scoring group (P < 0.001). Conclusion: Older adults in the highest-ERA-scoring group had the highest utilization of CABG or PCI. Patients with high ERA scores undergoing coronary revascularization were also at the highest risk of mortality. Providers should be aware that higher ERA scores can potentially predict outcomes in high-risk patients.

KW - Coronary bypass

KW - Geriatrics

KW - Mortality

KW - Percutaneous coronary intervention

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