Cardiology Letters 2021, 30(2):94-103

Case fatality rate among elderly patients with acute coronary syndrome and its temporal changes during the early 21st century in Slovakia

Dúbrava M¹, Baráková A², Jánošiová J¹, Hatala R³

¹ I. klinika geriatrie Lekárská fakulta Univerzita Komenského a Univerzitnej nemocnice, Bratislava

² Oddelenia vybraných národných zdravotných registrov, Národné centrum zdravotníckych informácií, Bratislava

³ Klinika kardiológie a angiológie Lekárská fakulta Slovenskej zdravotníckej univerzita a Národný ústav srdcových a cievnych chorôb a. s., Bratislava, Slovenská republika

Background: Acute coronary syndromes (ACS) account for a significant proportion of cardiovascular deaths. Precise information on age-specific case fatality rate (lethality) in elderly patients with ACS in Slovakia is missing. This study aimed to assess the temporal changes in the early and mid-term lethality of elderly patients during the last decade.

Patients and methods: Based on the data from the Slovak "Registry of the Acute Coronary Syndrome" (part of the "National Registry of Diseases of the Circulatory System") we have analysed the 30-day lethality and 1-year lethality of patients with ACS in the years 2010, 2015 and 2018. During these years data from 13 155 ACS cases were recorded. Patients aged ≥65 years represented 57.1% of all cases.

Results: In patients aged ≥65 years suffering from ACS the 30-day and 1-year lethality were 13.1% and 24.3%, respectively. We have confirmed a significantly and continuously increasing lethality with advanced age incl. those older than 60 years. After the age of 80 the differences between 30-day and 1-year lethality increased in 2018, mainly due to increase of the latter. This observation points out to the unmet need of improving out-patients management of elderly patients in first year post ACS. Most importantly, the presented data clearly demonstrate a significant decrease in lethality of ACS in the years 2010 to 2018, which was most impressive in elderly patients: their 30-day lethality decreased from 14.3% to 9.7% and 1-year lethality from 25.4% to 18.1%.

Conclusion: The observed important decrease of both early and mid-term lethality among elderly patients with ACS is a highly appreciated improvement of the efficacy of cardiovascular healthcare in Slovakia during the last decade. We presume that this achievement reflects mainly the improved accessibility of interventional coronary reperfusion also for the elderly population. Precise data on prognosis of patients with ACS is essential for a targeted improvement of care for patients with ACS, most of whom are elderly. This aim represents an integral part of efforts to decrease the high rate of avoidable deaths in Slovakia.

Keywords: acute coronary syndrome; myocardial infarction; case fatality rate; geriatrics; registry Slovak Republic

Published: February 1, 2021  Show citation