Claire Vesin

Predictive factors for all-cause mortality in the hospitalized elderly subject: The importance of arrhythmia

BACKGROUND In elderly patients traditional cardiovascular (CV) risk factors are poorly correlated with mortality and few data are available on determinants and consequences of supra-ventricular arrhythmia. In a cohort of 331 hospitalized elderly patients (mean age+/-SD=85+/-7 years), we assessed which CV characteristics were associated with all-cause mortality. AIM OF THE STUDY We wished to determine whether the presence of arrhythmia was associated with an increase of overall mortality in the hospitalized elderly population, and to ascertain which factors were associated with arrhythmia, in order to better understand the underlying mechanisms of both arrhythmia and arrhythmia-related mortality in these patients. RESULTS The relative hazard for overall mortality in the presence of arrhythmia was 2.40 (95% CI: 1.41-4.07; p<0.001), independent of major confounding factors, compared to sinus rhythm. Both arrhythmia and low DBP were independent predictors of mortality but no association or interaction between arrhythmia and DBP was observed. The left atrium diameter was found to be a predictor of arrhythmia, and when entered in the Cox regression analysis, it suppressed arrhythmia from the model predicting all-cause mortality. CONCLUSION In the hospitalized elderly, arrhythmia is an independent predictor of all-cause mortality, and left atrium size is an independent predictor of both arrhythmia and mortality, suggesting that links exist. Therapeutic management could therefore focus more on prevention of heart structure remodelling than on traditional risk factors.

Brachial Pulse Pressure and Cardiovascular Risk

To the Editor: The study by Mosley et al1 shows in a large population that, in the predictive value of cardiovascular (CV) risk, pulse pressure (PP) is less effective than systolic (SBP) or diastolic blood pressure (BP). This finding supports the usual approach of major current guidelines but also raises major questions related to SBP and PP (here measured exclusively at the site of the brachial artery). First, the classification into SBP or PP reflects, in fact, a particular approach in the clinical management of CV risk. The former …