Clinical Interventions in Aging (Sep 2013)
The relationship between Elder Risk Assessment (ERA) scores and cardiac revascularization: a cohort study in Olmsted County, Minnesota, USA
Abstract
Saurabh Sharma,1 Shruti Datta,1 Shahyar Gharacholou,1,2 Shahzad K Siddique,3 Stephen S Cha,4 Paul Y Takahashi1,5,6 1Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA; 2Division of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA; 3Shifa International Hospital, Islamabad, Pakistan; 4Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; 5Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA; 6Kogod Center of Aging, Mayo Clinic, Rochester, MN, USA 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
