Phenotyping of Self-Reported Health Profiles in Patients Aged 80 and 90 Years After Undergoing Coronary Angioplasty

Among patients aged ≥80 years, coronary angioplasty (PCI) combined with optimal medical treatment has shown to be the best treatment method. However, there is limited information on self-reported health status among the oldest elderly undergoing coronary angioplasty. This includes physical and mental health status, health-related quality of life, symptoms of anxiety and depression, and the occurrence of angina. Older individuals vary greatly in terms of physical and mental function, cognitive status, and social situations. Chronological age does not always correspond with biological age, and the number of comorbidities and frailty status can worsen health outcomes.

The study uses latent profile analysis, a person-oriented approach aimed at identifying groups with different health profiles based on specific combinations of the self-reported information included in the study. Furthermore, it examines whether identifying health profiles that characterize healthcare needs of elderly patients can make healthcare services more personalized following coronary angioplasty.

More specifically, the aim of the study was to phenotype self-reported health profiles in patients in the age groups of eighty and ninety years, 2 months after undergoing PCI. Additionally, the study aimed to investigate which sociodemographic, clinical, and lifestyle characteristics were associated with these profiles.

The following self-reported instruments were included in the study: the Fatigue (lack of energy) Scale, RAND-12 with composite scores for physical and mental health, the Hospital Anxiety and Depression Scale (HADS) with composite scores for anxiety and depression, the Myocardial Infarction Dimensional Assessment Scale (MIDAS) with 4 composite scores for physical and mental health status, uncertainty, and dependence, and the Seattle Angina Questionnaire with composite scores for physical limitation, quality of life, and the occurrence of angina symptoms.

In total, the study included 270 patients recruited from the CONCARD^PCI study, and three health profiles were identified with the following distribution of patients:

• The "Poor" health profile (29%) included patients with the lowest scores on the self-reported instruments. These patients had high levels of fatigue, low levels of physical and mental health, high levels of anxiety and depression, high levels of uncertainty and dependence, low quality of life, and monthly occurrences of angina symptoms.
• The "Moderate" health profile (39%) comprised patients with moderate to high scores on the self-reported instruments. These patients reported moderate fatigue, higher mental health scores compared to physical health, higher levels of depression compared to anxiety, moderate levels of uncertainty and dependence, high quality of life, and an absence of angina symptoms.
• The "Good" health profile (32%) comprised patients who generally had high scores on all the self-reported instruments.

In the study, univariate logistic regression analysis was used to identify the associations between the three health profiles and sociodemographic, clinical, and lifestyle characteristics. The results were as follows:

Elderly individuals classified under the "Poor" health profile compared to the "Good" health profile were older, female, had pre-existing diabetes, were frail, lived alone, had a low level of education, and had a low level of physical activity.

Elderly individuals classified under the "Poor" health profile compared to the "Moderate" health profile were from Denmark versus Norway, were older, had pre-existing diabetes, were frail, and had a low level of physical activity.

Elderly individuals classified under the "Poor" health profile compared to the "Moderate" health profile were female, had a history of cerebrovascular disease, were frail, and had a low level of physical activity.

However, further analyses (multinomial logistic regression analyses) showed that being frail (OR 2.50, 95% CI 1.17–5.33, P=0.017), having a low level of physical activity (OR 0.49, 95% CI 0.39–0.95, P= 0.003), and low alcohol intake (OR 0.61, 95% CI 0.39–0.95, P=0.028) were statistically associated with being classified under the "Poor" health profile versus the "Good" health profile. Higher age (OR 1.19, 95% CI 1.03–1.37, P=0.020) and lower physical activity levels (OR 0.64, 95% CI 0.43–0.97, P=0.034) were associated with being classified under the "Moderate" health profile compared to the "Good" health profile.

In summary, this study showed that around 70% of the included patients were classified under either the "Moderate" or the "Good" health profile 2 months after undergoing PCI. This indicates that invasive treatment alleviates the disease burden for elderly patients with coronary artery disease. Furthermore, the results show that the elderly patient group is heterogeneous. Therefore, it is desirable to offer personalized follow-up care after coronary angioplasty.

You can read the article here [https://www.heartlungcirc.org/article/S1443-9506(23)04313-5/abstract]