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THE STORM (acute coronary Syndrome in paTients end Of life and Risk assesMent) study
  1. Claudio Moretti1,
  2. Giorgio Quadri1,
  3. Fabrizio D'Ascenzo1,
  4. Maurizio Bertaina1,
  5. Federico Giusto1,
  6. Sebastiano Marra1,
  7. Corrado Moiraghi2,
  8. Luca Scaglione3,
  9. Mauro Torchio3,
  10. Giuseppe Montrucchio2,
  11. Mario Bo2,
  12. Massimo Porta2,
  13. Paolo Cavallo Perin2,
  14. Carlo Marinone3,
  15. Franco Riccardini2,
  16. Javaid Iqbal4,
  17. Pierluigi Omedè1,
  18. Serena Bergerone1,
  19. Franco Veglio2,
  20. Fiorenzo Gaita1
  1. 1Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy
  2. 2Dipartimento di Scienze Mediche, Città della Salute e della Scienze, Turin, Italy
  3. 3Dipartimento di Medicina generale e Specialistica, Città della Salute e della Scienza, Turin, Italy
  4. 4Department of Cardiology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
  1. Correspondence to Dr Claudio Moretti, Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Turin, 10126, Italy; drclamore{at}gmail.com

Abstract

Introduction Elderly patients with coexisting frailty and multiple comorbidities frequently present to the emergency department (ED). Because non-cardiovascular comorbidities and declining health status may affect their life expectancy, management of these patients should start in the ED. This study evaluated the role of Gold Standards Framework (GSF) criteria for identifying patients with acute coronary syndromes (ACS) approaching end of life.

Methods All consecutive patients admitted to the ED and hospitalised with a diagnosis of ACS between May 2012 and July 2012 were included. According to GSF criteria, patients were labelled as positive GSF status when they met at least one general criterion and two heart disease criteria; furthermore, traditional cardiovascular risk scores (the Global Registry for Acute Coronary Events (GRACE) score and the Age, Creatinine and Ejection Fraction (ACEF) score) were calculated and WHOQOL-BREF was assessed. Mortality and repeat hospitalisation due to cardiovascular and non-cardiovascular causes were evaluated at 3-month and 12-month follow-up.

Results From a total of 156 patients with ACS enrolled, 22 (14%) had a positive GSF. A positive GSF was associated with higher rate of non-cardiovascular events (22.7% vs 6.7%; p=0.03) at 3 months and higher rates of both cardiovascular and non-cardiovascular events (36% vs 16.4%; p=0.04 and 27.3% vs 6.7%; p=0.009, respectively) at 12 months. In multivariate analysis, an in-hospital GRACE score was a predictor of cardiovascular events, while a positive GSF independently predicted non-cardiovascular events.

Conclusions The GSF score independently predicts non-cardiovascular events in patients presenting with ACS and may be used along with traditional cardiovascular risk scores in choosing wisely the most appropriate treatment. The present results need to be externally validated on larger samples.

  • acute coronary syndrome
  • clinical assessment

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