Systematic re-evaluation of the diagnosis and treatment of coronary artery disease in hospitalized elderly: Impact on medication underuse. The multicenter IRIDIA study - 17/08/12

Doi : 10.1016/j.eurger.2012.04.001

S. Legrain ^a,^⁎,^b , S. Delpierre ^c , S. Lacaille ^a , P. Duc ^d , D. Lieberherr ^e , D. Bonnet ^a , H. Lahjibi-Paulet ^f , A. Gouronnec ^g , J. Boddaert ^h , B. Durand-Gasselin ⁱ , C. Roy ^j,^k , V. Faucounau ^l , P.-G. Steg ^b,^d,^k , F. Tubach ^b,^j,^k
^a AP–HP, Hôpital Bichat-Claude Bernard, Department of Geriatric Medecine, 75018 Paris, France
^b Université Paris Diderot-Paris 7, UFR de Médecine, Paris, France
^c AP–HP, Hôpital Bretonneau, Department of Geriatric Medecine, 75018 Paris, France
^d AP–HP, Hôpital Bichat-Claude Bernard, Department of Cardiology, 75018 Paris, France
^e AP–HP, Hôpital Paul Brousse, Department of Geriatric Medecine, 94804 Villejuif, France
^f AP–HP, Hôpital Européen Georges Pompidou, Department of Geriatric Medecine, 75015 Paris, France
^g AP–HP, Hôpital Charles Foix, Department of Geriatric Medecine, 94200 Ivry-Sur-Seine, France
^h AP–HP, Groupe Hospitalier Pitié-Salpétrière, Department of Geriatric Medecine, 75013 Paris, France
ⁱ Hôpital Saint-Joseph, Department of Geriatric Medecine, 75014 Paris, France
^j AP–HP, Hôpital Bichat-Claude Bernard, Département d’Épidémiologie, Biostatistique et Recherche Clinique, 75018 Paris, France
^k Institut National de la Santé et de la Recherche Médicale, CIE 801, 75018 Paris, France
^l Institut National de la Santé et de la Recherche Médicale, U698, 75018 Paris, France

Corresponding author. Hôpital Bretonneau, 23, rue Joseph-de-Maistre, 75018 Paris, France. Tel.: +33 1 53 11 18 04; fax: +33 1 53 11 168.

Abstract

Despite benefit of secondary prevention of coronary artery disease, evidence-based treatment are underused in very elderly patients. The objective of IRIDIA study is to evaluate feasibility of improving on the use of coronary artery disease evidence-based therapies through a intervention, based on diagnosis and treatment reassessment, in elderly inpatients.

Methods

Design: prospective cohort study with one-year follow-up. Setting: six acute care geriatric wards in France. Participants: consecutive inpatients≥75 years old with a supposed diagnosis of coronary artery disease (CAD).

Intervention

First step: reassessment of CAD diagnosis using coronary-oriented investigations. Second step: optimization of CAD treatment in accordance with international guidelines. Primary outcome: change in use of the recommended CAD treatment between admission and discharge. Secondary outcome: diagnosis optimization between admission and discharge.

Results

Two hundred and sixty-one participants (mean age 87 years [IQR: 83–92 years]) with a high prevalence of comorbidities, cognitive impairment, and disability. The CAD diagnosis was considered confirmed at inclusion in 138 of the 261 patients (53%) with an evident underuse of β-blockers and antiplatelet agents. The impact of the intervention on CAD diagnosis was 40%; for 74 patients, the diagnosis remained uncertain. For patients with confirmed CAD (n=178), the treatment optimization resulted in a increase in use of evidence-based therapy, with rates of 66% for β-blockers and 79% for antiplatelet agents, without significant complications at 1 year.

Conclusion

This multicenter study demonstrated the feasibility of improving on the use of CAD evidence-based therapies through a simple intervention, including CAD diagnosis optimization and treatment reassessment, in a very elderly population with comorbidities in an acute-care setting.