Impact of Geriatric Events on Clinical Outcomes and Resource Utilization of Acute Coronary Syndrome Hospitalizations

Background The effect of geriatric events (GEs) on outcomes of acute coronary syndrome (ACS) admissions is poorly understood. We evaluated the prevalence and impact of GEs on clinical outcomes and resource utilization of older patients admitted with ACS. Methods Using the 2018 National (Nationwide) Inpatient Sample, we analyzed all elective hospitalizations for ACS in older adults (age > 65 years) and a younger reference group (age 55-64). Nationally-weighted descriptive statistics were generated for GEs based on ACS subtypes. Multivariate logistic regression models controlling for comorbidities, frailty, patient procedure, and hospital-level variables were used to estimate the association of age with GEs and GEs with outcomes. Results Out of 403,760 admissions analyzed, 71.9% occurred in older adults (>65 years). The overall rate of any GE in older adults with ACS was 3.4%. With advancing age, the number of GEs was found to significantly increase (p<0.001). After adjustments, having any GE was found to have a significant impact on mortality (adjusted OR (AOR): 1.32; 95%CI: 1.15-1.54; p < 0.001), post-myocardial infarction (MI) complications (AOR: 1.53; 95%CI: 1.36-1.71; p < 0.001), prolonged hospital stays (AOR: 2.97; 95%CI: 2.56-3.30; p < 0.001), and non -home (acute care and skilled nursing home) discharge (AOR: 1.68; 95%CI: 1.53-1.85; p < 0.001). The occurrence of GEs was also associated with a substantial increase in total hospitalization costs with a mean increase of $48,325.22 +/- $5,539 (p < 0.001). A dose-response relationship was established between GEs and all outcomes. Limitations of the study included the use of retrospective data and an administrative database. Conclusion Geriatric events were found to significantly worsen outcomes for older adults with ACS. There is, therefore, a need for increased awareness and effective management of GEs in older adults to improve their health outcomes and reduce the burden on the healthcare system.