Baseline characteristics:
During 26 June 2020 to 13 October 2020, a total of 12,262 subjects were admitted to the hospital (Figure 1). Out of this 4,329 (35.3%) were older adults of >60 years of age. The total number of subjects who were admitted with or developed an Acute Coronary Syndrome (ACS) after admission were 310 (7.16%). The data of 310 older adults were included in the study after screening according to the inclusion criteria. Of these 94 (30.3%) subjects were admitted primarily with Acute Coronary Syndrome (ACS) and they were taken as controls (GROUP-I). The rest of 216 subjects (69.6%) were admitted for other illnesses following which they developed ACS during the course of the illness (GROUP-II). In Group II, the reason for the current admission to the hospital is shown in Table no: 1. Majority of the subjects were admitted due to Acute kidney injury (n=84, 27.1%) following which they developed an ACS in hospital. The second most common cause was Sepsis, which was seen in 51 subjects (16.5%). The rest of the causes are shown in Table no: 1.
Comparison between the groups:
The major observations seen in the two groups are shown in Table no: 2. The mean age was similar between the groups, with subjects admitted to the hospital for non cardiac illness being older (72.65 vs. 71.03 years). The mean number of days hospitalized were also almost similar with an increase among the subjects admitted for non cardiac illness (10.34 vs. 9.6 days). Male subjects were more in both the groups. Female subjects were more in the group admitted with non cardiac illness (n=58, 26.9% vs. n=24, 25.5%).
In the past medical history, Systemic hypertension (n=158, 73.1% vs. n=65, 69.1%), Coronary artery disease (n=100, 46.3% vs. n=41, 43.6%), Dyslipidemia (n=79, 36.6% vs. n=27, 28.7%), Cerebro vascular accident (n=27, 12.5% vs. n=8, 8.5%) and history of Coronary artery bypass graft (n=24, 11.1% vs. n=9, 9.6%) was seen more among the subjects admitted with non cardiac illness who later developed an ACS. The use of Antiplatelets (n=131, 60.6% vs. n=52, 55.3%), Beta blockers (n=107, 49.5% vs. n=45, 47.9%) and ACE inhibitors (n=6, 2.8% vs. n=2, 2.1%) on admission was more among the subjects who were admitted to the hospital due to non-cardiac illnesses. Initial cardiac troponin elevation was seen more among the subjects admitted with ACS (n=91, 96.8% vs. n=200, 92.6%) but the subsequent values were elevated more among the subjects in the Group II. There was a higher percentage of non ST elevation ACS among the subjects who were admitted to the hospital due to non-cardiac illnesses (n=195, 90.3% vs. n=75, 75.5%, p 0.001). On an echocardiogram, left ventricular dysfunction was seen more in subjects of Group II (n=73, 33.8% vs. n=27, 28.7%). Only a screening echocardiogram was performed in most subjects of Group II (n=42, 19.4% vs. n=11, 11.7%). Medical line of management (n=167, 77.3% vs. n=59, 69.2%) was given mostly in the Group II. There was a higher use of use of angiotensin converting enzyme inhibitors (n=4, 1.9% vs. n=0, 0%), Antiplatelets (n=149, 69% vs. n=62, 65.9%), Heparin (n=144, 31.5% vs. n=29, 30.9%) and Statin (n=144, 66.7% vs. n=59, 62.8%) among Group II. Coronary angiogram (n=13, 13.8% vs. n=13, 6%, p 0.014) and Percutaneous transluminal coronary angioplasty (n=13, 13.8% vs. n=13, 6%, p 0.045) was more in Group I.
More subjects were stabilized with medication (n=167, 76.4% vs. n=59, 62.5%) and most of them succumbed to death (n=29, 13.4% vs. n=12, 12.8%) in Group II during hospitalization. During hospital admission, majority of the subjects in Group II had depression (n=63, 52.5% vs. n=28, 46.7%). Mild to moderate (n=80, 39.6% vs. n=21, 23.3%, p 0.014) and moderate to severe cognitive impairment (n=37, 18.3% vs. n=16, 17.8%, p 0.014) was also seen more in Group II. Majority of these subjects were also disabled (n=105, 48.6% vs. n=32, 34%, p 0.059) in Group II.
After 30 days in Group II, there was an increased number of repeat admissions (n=25, 13.4% vs. n=8, 9.8%) and death (n=36, 19.3% vs. n=15, 18.3%) as shown in Table no: 3. There was also an increase in depression (n=54, 41.9% vs. n=11, 17.2%, p 0.001). Mild to moderate (n=29, 19.2% vs. n=6, 9%, p 0.057) and moderate to severe (n=11, 7.3% vs. n=2, 3%, 0.057) cognitive impairment was also observed in Group II. There was a higher number of patients who required assistance (n=90, 59.6% vs. n=38, 56.7%, p 0.039) and who were disabled (n=36, 23.8% vs. n=9, 13.4%, p 0.039) in Group II.
After 6 months in Group II, there was a higher number of repeat admission (n=21, 13.9% vs. n=6, 9%), and death (n=27, 17.9% vs. n=7, 10.4%) as shown in Table no: 4. Depression (n=31, 26.7% vs. n=12, 20%) was seen more in Group II. More number of these subjects had mild to moderate (n=17, 13.7% vs. n=4, 6.7%) and moderate to severe (n=5, 4% vs. n=0, 0%) cognitive impairment. Higher number of these subjects required assistance (n=58, 46.8% vs. n=27, 45%, p 0.074) and were disabled (n=22, 17.7% vs. n=4, 6.7%, p 0.074).