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Biomedical subjects

Francisco Lopez-Jimenez

Publications and source records attributed to Francisco Lopez-Jimenez.

At least 19 recordsLinked to original sources
PubMed2006

Comparison of apolipoprotein-B/apolipoprotein-AI in subjects with versus without the metabolic syndrome.

Recent studies have suggested that the apolipoprotein-B (apo-B)/apolipoprotein-AI (apo-AI) ratio predicts cardiovascular risk better than any of the cholesterol indexes. The aim of the present study was to assess if the apo-B/apo-AI ratio is related to the metabolic syndrome and its components. Data were analyzed from 2,964 subjects (mean age 48 years; 1,516 men, 1,448 women) from the National Health and Nutrition Examination Survey III with apolipoprotein data who were evaluated for the metabolic syndrome and its components. The metabolic syndrome was defined according to the criteria of the National Cholesterol Education Program Adult Treatment Panel III and the International Diabetes Federation. The mean values of the apo-B/apo-AI ratio in subjects with and without the metabolic syndrome were compared. Overall, the median distribution of the apo-B/apo-AI ratio was significantly greater (p <0.0001) in subjects with the Adult Treatment Panel III metabolic syndrome (0.90) than without (0.69). The apo-B/apo-AI ratio was associated significantly with each of the metabolic syndrome components, in descending order of magnitude: low high-density lipoprotein cholesterol (odds ratio [OR] 5.7), high triglycerides (OR 4.7), high waist circumference (OR 2.6), high fasting glucose (OR 1.9), and high blood pressure (OR 1.5). The apo-B/apo-AI ratio was also different between subjects with and without the metabolic syndrome. Mean values of apo-B/apo-AI increased significantly as the numbers of metabolic syndrome components increased in men (p <0.0001) and women (p <0.0001). After excluding high-density lipoprotein cholesterol and triglycerides as criteria for the metabolic syndrome, the association between means persisted (analysis of variance p <0.0001) in men and women. Apo-B/apo-AI was significantly associated with the presence of the metabolic syndrome (OR 5.1, p <0.0001). In conclusion, the apo-B/apo-AI ratio is strongly associated with the presence of individual metabolic syndrome components, with the metabolic syndrome itself, and with insulin resistance. An elevated apo-B/apo-AI ratio may constitute an important feature of the metabolic syndrome and may provide an additional mechanism to explain the increased cardiovascular risk in subjects with this syndrome.

Adult↗
PubMed2006

Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies.

BACKGROUND: Studies of the association between obesity, and total mortality and cardiovascular events in patients with coronary artery disease (CAD) have shown contradictory results. We undertook a systematic review to determine the extent and nature of this association. METHODS: We selected cohort studies that provided risk estimates for total mortality, with or without cardiovascular events, on the basis of bodyweight or obesity measures in patients with CAD, and with at least 6 months' follow-up. CAD was defined as history of percutaneous coronary intervention, coronary artery bypass graft, or myocardial infarction. We obtained risk estimates for five predetermined bodyweight groups: low, normal weight (reference), overweight, obese, and severely obese. FINDINGS: We found 40 studies with 250,152 patients that had a mean follow-up of 3.8 years. Patients with a low body-mass index (BMI) (ie, <20) had an increased relative risk (RR) for total mortality (RR=1.37 [95% CI 1.32-1.43), and cardiovascular mortality (1.45 [1.16-1.81]), overweight (BMI 25-29.9) had the lowest risk for total mortality (0.87 [0.81-0.94]) and cardiovascular mortality (0.88 [0.75-1.02]) compared with those for people with a normal BMI. Obese patients (BMI 30-35) had no increased risk for total mortality (0.93 [0.85-1.03]) or cardiovascular mortality (0.97 [0.82-1.15]). Patients with severe obesity (> or =35) did not have increased total mortality (1.10 [0.87-1.41]) but they had the highest risk for cardiovascular mortality (1.88 [1.05-3.34]). INTERPRETATION: The better outcomes for cardiovascular and total mortality seen in the overweight and mildly obese groups could not be explained by adjustment for confounding factors. These findings could be explained by the lack of discriminatory power of BMI to differentiate between body fat and lean mass.

Angioplasty, Balloon, Coronary↗
PubMed2006

A comparative analysis of short- and long-term outcomes after ventricular fibrillation out-of-hospital cardiac arrest in patients with ischemic and nonischemic heart disease.

Although ventricular fibrillation (VF) out-of-hospital cardiac arrest (OHCA) occurs primarily in the setting of severe ischemic heart disease (IHD), a significant proportion of events occurs in patients who do not have severe IHD. The relative effect of IHD on survival after VF OHCA is unknown. All residents of Rochester, Minnesota, who presented with a VF OHCA from November 1990 to December 2004, treated by emergency medical services, were included in the study. During the study, emergency medical services treated 208 patients (64.1 +/- 13.6 years of age) for VF OHCA, with an average call-to-shock time of 6.3 +/- 1.8 minutes. Of these patients, 156 had IHD and 39 had non-IHD. In 13, the underlying heart disease was unknown. Eighty-seven patients (41.8%) survived to hospital discharge with neurologic recovery (66 with IDH [42%] vs 21 with non-IHD [54%], p = 0.211)]. Five-year survival was 79 +/- 6% for patients with IHD versus 100% for those with non-IHD (p = 0.047). After adjustment for other patient characteristics, IHD was not predictive of 5-year survival (hazard ratio [HR] 2.2, 95% confidence interval [CI] 0.7 to 9.8, p = 0.177). Variables associated with poor outcomes included age >65 years (HR 4.9, 95% CI 2.0 to 13.4, p = 0.0003), ejection fraction <0.35% (HR 3.0, 95% CI 1.3 to 7.3, p = 0.012), and hypertension (HR 4.9, 95% CI 1.4 to 16.3, p = 0.001). In patients with IHD, use of an implantable cardioverter-defibrillator (HR 0.32, 95% CI 0.16 to 0.88, p = 0.024) and statin therapy (HR 0.68, 95% CI 0.17 to 0.73, p = 0.001) were associated with decreased mortality. In conclusion, compared with patients with non-IHD, those with IHD had similar short- and long-term survival rates. Long-term survival in patients with IHD was primarily influenced by other co-morbid conditions. Nonetheless, in patients with IHD, use of an implantable cardioverter-defibrillator and statin therapy were associated with higher long-term survival rates.

Age Factors↗
PubMed2006

CardioVision 2020: program acceptance and progress after 4 years.

OBJECTIVE: To report program acceptance and progress after 4 years of a heart disease prevention program. SUBJECTS: All Olmsted County, Minnesota residents aged >/=20 years. METHODS: The analysis is based on independent population-based interview samples from 1999, 2000, 2001, and 2003; a dietary questionnaire mailed to interviewees; and blood pressure and cholesterol data from medical records of consenting Olmsted County residents. National, Minnesota, and Olmsted County Behavioral Risk Factor Surveillance System trends for fruit and vegetable consumption, body mass index, participation in physical activity, and smoking are compared. The data were analyzed in 2005. RESULTS: More than 90% of the population considers CardioVision 2020 to be a good, very good, or excellent idea. The program is associated with a 25% reduction in the number of people exposed to environmental tobacco smoke and small but significant increases in consumption of fruits and daily physical activity. The population meeting the serum cholesterol goal increased from 52.0% in 1999 to 57.5% in 2003, and the population meeting the blood pressure goal increased from 53.7% in 1999 to 59.9% in 2003. However, attempts to quit smoking and the amount of time spent in physical activity did not increase. By 2003, nearly 9% of the population reported making a behavior change because of CardioVision 2020. Compared to Minnesota and national trends, fruit and vegetable consumption increased significantly in Olmsted County. CONCLUSIONS: The population of Olmsted County views CardioVision 2020 in a positive light. Positive changes in several personal behaviors and risk factor levels have occurred.

Adult↗
PubMed2005

Subepicardial adipose tissue and the presence and severity of coronary artery disease.

BACKGROUND: Mechanistic studies suggest that paracrine effects of subepicardial adipose tissue may promote coronary atherosclerosis, but this has not been confirmed in clinical studies. METHODS AND RESULTS: Of 180 consecutive patients who underwent echocardiography and coronary angiography within 1 week (mean 2.5+/-2.0 days), 139 (80 men, 68+/-13 years) were studied. Subepicardial adipose tissue on the free wall of right ventricle was measured at end-diastole from parasternal long- and short-axis views of three cardiac cycles. Angiograms were analyzed for the presence, extent and severity of coronary artery disease (CAD), using a 27-segment classification. The number of segments with at least 20% (CAGE > or = 20) and 50% (CAGE > or = 50) stenosis was recorded. Age showed a significant correlation with subepicardial adipose tissue thickness measured from parasternal long- (r=0.25, p=0.003) and short-axis view (r=0.23, p=0.01). No significant correlation was found between subepicardial adipose tissue thickness and any angiographic or other clinical variables (p>0.05). Neither the proportion of patients with significant or any CAD nor the severity score, CAGE > or = 20, and CAGE > or = 50 among each of four quartiles was significantly associated with subepicardial adipose tissue thickness. CONCLUSIONS: In this selected population, the amount of subepicardial adipose tissue thickness was not associated with the severity of CAD. Whether subepicardial adipose tissue has any atherosclerotic effect remains to be proven.

Adipose Tissue↗
PubMed2005

Relation of body mass index to fatal and nonfatal cardiovascular events after cardiac rehabilitation.

The aim of the present study was to determine whether body mass index (BMI) influences survival and recurrent cardiovascular events in a cardiac rehabilitation population. We followed 389 consecutive entrants to cardiac rehabilitation for 6.4 +/- 1.8 years. Patients were stratified into 3 groups: normal (BMI 18 to 24.9 kg/m(2)), overweight (BMI 25 to 29.9 kg/m(2)), and obese (BMI > or =30 kg/m(2)). Total and cardiovascular mortality were inversely associated with BMI category in bivariate models. However, only cardiovascular mortality was significant after adjustment for age and gender (p < 0.044), with cardiovascular death rates of 10% in normal, 8% in overweight, and 2% in obese patients. The rates of nonfatal recurrent events were 10% in normal, 24% in overweight, and 25% in obese patients. Our data indicate that BMI is inversely related to cardiovascular mortality but positively related to the risk of nonfatal recurrent events.

Age Factors↗
PubMed2005

Obstructive sleep apnea and hypertension.

There is growing evidence of a causal relationship between obstructive sleep apnea (OSA) and hypertension. Untreated OSA may have direct and deleterious effects on cardiovascular function and structure through several mechanisms, including sympathetic activation, oxidative stress, inflammation, and endothelial dysfunction. OSA may contribute to or augment elevated blood pressure levels in a large proportion of the hypertensive patient population. It is important to consider OSA in the differential diagnosis of hypertensive patients who are obese. OSA should be especially considered in those hypertensive patients who respond poorly to combination therapy with antihypertensive medications.

Animals↗
PubMed2005

Action on obesity: report of a mayo clinic national summit.

In May 2004, representatives from local, state, and national public and private organizations met in Rochester, Minn, for the Action on Obesity Summit hosted by Mayo Clinic. The overall goal of this summit was to identify creative and effective strategies to Increase the US population's physical activity and improve nutrition to reverse the increasing prevalence of obesity. Ideas generated from selected abstract presentations and breakout sessions were prioritized and incorporated into an action model (available at www.actiononobesity.org) deemed feasible for implementation into most communities. Highlights of the presentations included a company that reported lower than expected health care expenditures secondary to a work site wellness program, a national initiative to increase physical activity (www.americaonthemove.org), and innovative work site nutritional strategies. The implementation model that emerged contained certain themes. Coordinated action at all levels will be required to substantially impact the increasing prevalence of obesity. Educational messages should be simple, consistent, tailored, and linked to benefits. Healthy food options in vending machines and restaurants and increased opportunities for daily physical activity should be available in schools, work sites, and communities. Legislative and policy changes should promote physical activity and improve nutrition. Support for research should be encouraged and outcome measures for interventions documented. A second Action on Obesity Summit is planned for June 9 and 10, 2005, that will review the progress made in the intervening year and continue to refine the implementation model to help address the obesity epidemic, one of the greatest public health problems facing the United States.

Humans↗
PubMed2005

Safety and efficacy of bariatric surgery in patients with coronary artery disease.

OBJECTIVE: To determine the safety and efficacy of bariatric surgery in obese patients with documented coronary artery disease (CAD). PATIENTS AND METHODS: Among patients with class II or III obesity who underwent bariatric surgery between March 1995 and January 2002 at the Mayo Clinic in Rochester, Minn, the rates of major in-hospital cardiovascular complications and mortality of 52 patients with clinical CAD were compared with those of 507 patients without CAD. The efficacy of bariatric surgery was measured by changes in body weight and other cardiovascular risk factors at follow-up. RESULTS: There were no in-hospital deaths in either group. Three patients with documented CAD (5.8%; 95% confidence interval, 0%-12.2%) and 7 patients without CAD (1.4%; 95% confidence interval, 0.4%-2.4%) had cardiovascular complications (P=.06). After a mean follow-up of 2.5 years (range, 77-2403 days) of patients with CAD, the following values decreased postoperatively (all at P<.001): weight, from 147+/-36 kg to 103+/-22 kg; body mass index, from 50+/-11 kg/m2 to 36+/-9 kg/m2; fasting serum glucose, from 149+/-52 mg/dL to 113+/-31 mg/dL; glycosylated hemoglobin, from 9%+/-3% to 6%+/-2%; and blood pressure, from 142/82 mm Hg to 132/73 mm Hg. Low-density lipoprotein cholesterol decreased postoperatively from 116+/-31 mg/dL to 75+/-26 mg/dL, and triglycerides decreased from 198+/-85 mg/dL to 119+/-52 mg/dL (P<.01 for both). CONCLUSION: Bariatric surgery should be considered for treating patients with CAD and class II or III obesity.

Adult↗
PubMed2004

The national cholesterol education program diet vs a diet lower in carbohydrates and higher in protein and monounsaturated fat: a randomized trial.

BACKGROUND: In the United States, obesity is a major clinical and public health problem causing diabetes, dyslipidemia, and hypertension, as well as increasing cardiovascular and total mortality. Dietary restrictions of calories and saturated fat are beneficial. However, it remains unclear whether replacement of saturated fat with carbohydrates (as in the US National Cholesterol Education Program [NCEP] diet) or protein and monounsaturated fat (as in our isocaloric modified low-carbohydrate [MLC] diet, which is lower in total carbohydrates but higher in protein, monounsaturated fat, and complex carbohydrates) is optimal. METHODS: We randomized 60 participants (29 women and 31 men) to the NCEP or the MLC diet and evaluated them every 2 weeks for 12 weeks. They were aged 28 to 71 years (mean age, 44 years in the NCEP and 46 years in the MLC group). A total of 36% of participants from the NCEP group and 35% from the MLC group had a body mass index (calculated as weight in kilograms divided by the square of height in meters) greater than 27. The primary end point was weight loss, and secondary end points were blood lipid levels and waist-to-hip ratio. RESULTS: Weight loss was significantly greater in the MLC (13.6 lb) than in the NCEP group (7.5 lb), a difference of 6.1 lb (P = .02). There were no significant differences between the groups for total, low density, and high-density lipoprotein cholesterol, triglycerides, or the proportion of small, dense low-density lipoprotein particles. There were significantly favorable changes in all lipid levels within the MLC but not within the NCEP group. Waist-to-hip ratio was not significantly reduced between the groups (P = .27), but it significantly decreased within the MLC group (P = .009). CONCLUSIONS: Compared with the NCEP diet, the MLC diet, which is lower in total carbohydrates but higher in complex carbohydrates, protein, and monounsaturated fat, caused significantly greater weight loss over 12 weeks. There were no significant differences between the groups in blood lipid levels, but favorable changes were observed within the MLC diet group.

Adult↗
PubMed2004

Alcohol consumption and cardiovascular disease mortality in hypertensive men.

BACKGROUND: Heavy alcohol drinking is associated with a dose-dependent increase in blood pressure, but data on the relation between alcohol consumption and mortality in hypertensive patients are sparse. OBJECTIVE: To assess the relation between light to moderate alcohol consumption and total mortality from cardiovascular disease (CVD) among men with hypertension. PARTICIPANTS AND DESIGN: From the Physicians' Health Study enrollment cohort of 88,882 men who provided self-reported information on alcohol intake, we identified a group of 14,125 men with a history of current or past treatment for hypertension who were free of myocardial infarction, stroke, cancer, or liver disease at baseline. Main Outcome Measure Comparison of total and CVD mortality among men with hypertension who had reported to be either nondrinkers or rare drinkers, or light to moderate drinkers. RESULTS: During 75,710 person-years of follow-up, there were 1018 deaths, including 579 from CVD. Compared with individuals who rarely or never drank alcoholic beverages, those who reported monthly, weekly, and daily alcohol consumption, respectively, had multivariate adjusted relative risks (RRs) for CVD mortality of 0.83 (95% confidence interval [CI], 0.62-1.13), 0.61 (CI, 0.49-0.77), and 0.56 (CI, 0.44-0.71) (P<.001 for linear trend). In the same groups, RRs for total mortality were respectively 0.86 (CI, 0.67-1.10), 0.72 (CI, 0.60-0.86), and 0.73 (CI, 0.61-0.87) (P<.001 for linear trend). Among men with a systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure of 90 mm Hg or higher, the RRs for CVD mortality were, respectively, 1.00 (referent), 0.82 (CI, 0.56-1.21), 0.64 (CI, 0.48-0.85), and 0.56 (CI, 0.42-0.75) (P<.001 for linear trend). On the other hand, we found no significant association between moderate alcohol consumption and cancer mortality (P =.8 for linear trend). CONCLUSION: These results, which require confirmation in other large-scale studies, suggest that light to moderate alcohol consumption is associated with a reduction in risk of total and CVD mortality in hypertensive men.

Aged↗
PubMed2004

Measurement of ejection fraction after myocardial infarction in the population.

OBJECTIVES: To assess the secular trends in left ventricular ejection fraction (LVEF) assessment after myocardial infarction (MI) and to identify the determinants of testing. DESIGN: A population-based MI incidence cohort. METHODS: The use of tests measuring LVEF (echocardiography, radionuclide, and left ventricular [LV] angiography) was examined among all consecutive residents of Olmsted County, MN, hospitalized for a validated incident MI between 1979 and 1998. Baseline characteristics and outcome were ascertained from community medical records. RESULTS: Among 2,317 patients with incident MI, LVEF assessment increased from 1979 to 1986 (22 to 85%; p value for trend = 0.0001) to stabilize thereafter until 1998. During the most recent decade, LVEF was measured during the hospital stay in 81% of the patients. Characteristics associated with lesser use of tests included older age and measurement of ejection fraction within 1 year prior to the index MI. Larger MI size, prolonged hospital stay, and involvement of a cardiologist as a care provider were positively associated with determination of LVEF. CONCLUSIONS: Measurement of LVEF after MI increased in the last 2 decades, but there continues to be a group of patients in whom it is not done. Given the potential benefits of LVEF measurement, including knowledge for risk stratification and therapeutic choices as underscored in recent practice guidelines, there may be additional opportunities for improving outcomes by ensuring its more consistent use. However, as testing for LVEF differs according to patient characteristics, reliance on selected clinically performed LVEF measurements will result in biased estimates of the prevalence of LV dysfunction after MI.

Adult↗
PubMed2004

Prevalence and secular trends of excess body weight and impact on outcomes after myocardial infarction in the community.

OBJECTIVES: To determine the trends in the prevalence of overweight and obese individuals among patients with myocardial infarction (MI), and to assess the association between weight and outcomes after MI. DESIGN: Population-based cohort study. METHODS: MIs occurring in Olmsted County, MN, between 1979 and 1998 were validated using standardized criteria. Clinical characteristics and outcomes were ascertained from community medical records. The prevalence and trends of excess weight and its association with outcomes were analyzed. RESULTS: Sixty-four percent of the 2,277 subjects with incident MI were overweight or obese. The prevalence of overweight/obese patients increased from 58% in the period from 1979 to 1983, to 72% in the period from 1994 to 1998 (p < 0.001), while the prevalence of class 3 obesity (body mass index >or= 40) increased from 0.6 to 4.4%. Overweight and obese patients were more likely to have diabetes, hypertension, familial coronary disease, and hyperlipidemia than persons with normal weight but less likely to have comorbidities (obstructive lung disease, heart failure, cancer, renal failure, and stroke) [all p values < 0.05]. When compared to patients with normal weight, after adjusting for age and other confounders, overweight and obese patients had a lower mortality (risk ratio [RR], 0.84; 95% confidence interval [CI], 0.73 to 0.96 for overweight; and RR, 0.85; 95% CI, 0.72 to 1.02 for obese) and a similar risk of cardiac events. CONCLUSION: The prevalence of overweight and obese individuals among patients with MI is high and increased over time. Despite a higher prevalence of other cardiovascular risk factors among patients with excess weight, these patients did not experience worse outcomes, underscoring the need to further study the paradoxical relation between weight and post-MI outcomes.

Aged↗
PubMed2003

Heart failure after myocardial infarction: prevalence of preserved left ventricular systolic function in the community.

BACKGROUND: Studies have reported that a large proportion of the cases of congestive heart failure (CHF) with mixed etiologies have preserved left ventricular systolic function. Whether this is the case in subjects with CHF after myocardial infarction (MI) is not known. This study was undertaken to examine the prevalence and characteristics associated with CHF in patients who had preserved ejection fraction (LVEF) after MI. METHODS: Clinical characteristics and LVEF were ascertained in a population-based cohort of patients with CHF after incident MI in Olmsted County, Minn. All MIs were validated by use of standardized epidemiological criteria, and all episodes of CHF were validated by use of Framingham criteria. RESULTS: Between 1979 and 1994, 1658 patients had an MI, and 644 of these patients (38%) had CHF during 7.4 +/- 5.4 years of follow-up. Of these patients, 395 (61%) underwent LVEF assessment. Preserved LVEF (ie, > or =50%) was present in 30% of cases, and this proportion did not change with time. The proportion of women with CHF and preserved LVEF (37%) was greater than the proportion of men (23%, P =.002). The positive association between female sex and preserved LVEF remained significant after adjustment (odds ratio 1.97, 95% CI 1.26-3.07, P =.003). The highest tertile of peak creatinine phosphokinase level was negatively associated with preserved LVEF (odds ratio 0.51, 95% CI 0.29-0.89). CONCLUSION: A notable proportion of cases of CHF after MI have preserved LVEF. This underscores the burden of CHF with preserved LVEF in a well-defined group of patients with documented coronary disease. CHF with preserved LVEF after MI is associated with female sex and smaller MI size.

Aged↗
PubMed2002

Effect of cigar smoking on endothelium-dependent brachial artery dilation in healthy young adults.

BACKGROUND: Cigar smoking has become a quickly growing trend among teenagers, women, and young adults. The objective was to explore whether cigar smoking affects flow-mediated vasodilation in healthy, non-smoking young adults. METHODS: This was a prospective randomized trial with open design. It was performed in a cardiology teaching program in a private community hospital that serves as a major referral center within the greater Miami area. Apparently healthy, non-smoking young adult cardiology trainees and staff between the ages of 20 and 45 years were randomly assigned to a cigar smoking group (n = 15) or a control group (n = 14). The main outcome measures were the difference in percent diameter increase in the brachial artery after reactive hyperemia and sublingual nitroglycerin between members of the cigar smoking and control groups at baseline, measured after cigar smoking, and at 5 hours. RESULTS: Twenty-nine participants were randomized. Percent diameter increase in the brachial artery was measured with the use of high-resolution ultrasonography. Baseline percent diameter increase after reactive hyperemia and sublingual nitroglycerin was similar in both groups (6.2% vs 6.7%, P = .4 and 22% vs 23%, P = .5, respectively). We observed a 2.5% increase in brachial artery diameter with hyperemia after cigar smoking compared with a 9.4% increase in the control group, P = .045. Values after nitroglycerin were similar between groups, P = .2. Between-group analysis showed no significant difference in percent dilation after reactive hyperemia at 5 hours, P = .4, but a significant difference was seen after sublingual nitroglycerin, P = .02. CONCLUSIONS: These data are compatible with the possibility that cigar smoking may have an acute effect on endothelium-dependent, flow-mediated brachial artery dilation and do not support the possibility of an immediate effect on endothelium-independent vasodilation. Taken together, these results suggest that cigars are not an innocuous alternative to cigarette smoking.

Adult↗
PubMed2002

Outcome and cost-effectiveness of cardiopulmonary resuscitation after in-hospital cardiac arrest in octogenarians.

CONTEXT: Octogenarians are the fastest growing segment of the population and little is known about the results of cardiopulmonary resuscitation (CPR) after in-hospital cardiac arrest in this population. OBJECTIVE: We sought to investigate the clinical benefit and cost-effectiveness of CPR after in-hospital cardiac arrest in octogenarians. MAIN OUTCOME MEASURE: Years of life saved. DESIGN: Effectiveness data were obtained from a review of 91,372 hospital discharges from January 1st, 1993 until June 30th, 1996. Cardiac arrest was reported in 956 patients. The study group consisted of 474 patients > or = 80 years old. CPR costs included equipment and training, physician and nursing time and medications. Post-CPR expenses included in-hospital true cost, repeat hospitalizations, physician office visits, nursing home, rehabilitation, and chronic care hospital costs. Life expectancy of the patients who were still alive at the end of the study was estimated from census data. A utility of 0.8 was used to calculate quality-adjusted-life years saved (QALYS). We used a societal perspective for analysis. RESULTS: The study population was 86 +/- 4.8 years old (range 80-103), and 42% were male. Fifty-four patients (11%) were discharged alive, 35 to a chronic care facility and 19 to their home. Assuming that a cardiac arrest without CPR has 100% mortality, 12 octogenarians required treatment with CPR in order to save one life to hospital discharge. Similarly, 29 octogenarian patients with cardiac arrest have to be treated with CPR to net one long-term survivor (mean survival 21 months, with a range from 9 to 48 months). The cost-effectiveness ratio, after estimating the life expectancy of octogenarian survivors, was USD 50,412 per year of life saved, and USD 63,015 per QALYS. However, a utility of 0.5 yielded a cost of USD 100,825 per QALYS. CONCLUSION: In comparison with other life-saving strategies, CPR in octogenarians is effective. The favorable cost-effectiveness ratio is highly dependent on the patients' preference for quality rather than quantity of life, as expressed by the utility assumptions.

Age Factors↗