The additional value of routine electrocardiograms in cardiovascular risk management of older people

Figures & data

Figure 1.  Annual numbers of survivors and deceased in the Leiden 85-plus Study.

Table I.  Sociodemographic and cardiovascular characteristics at age 85 years (n = 566).

	n	%
Sociodemographic characteristics
Women	377	67
Monthly family income > €750	273	49
Non-institutionalized living	464	82
Additional education after primary school	196	35
History of cardiovascular disease
No cardiovascular pathology	282	50
One or more cardiovascular pathologies	284	50
Specification of cardiovascular pathologies
Myocardial infarction	57	10
Stroke	55	10
Angina pectoris	107	19
Arrhythmia	115	20
Peripheral arterial disease	62	11
Heart failure	70	12
Major ECG abnormalities
Prior myocardial infarction	52	9
Atrial fibrillation	56	10
Classic risk factors
Hypertension	325	58
Hypercholesterolemia	125	22
Diabetes mellitus	91	16
Present or past smoking	271	49

Notes: History of cardiovascular disease (according to general practitioner) included myocardial infarction, stroke, angina pectoris, arrhythmia, peripheral arterial disease and heart failure. Major ECG abnormalities included prior myocardial infarction (Minnesota Codes 1-1 or 1-2, excluding 1-2-8) and atrial fibrillation (Minnesota Code 8-3-1). Hypertension defined as systolic blood pressure > 160 mmHg or history of hypertension (according to general practitioner). Hypercholesterolemia defined as total cholesterol level ≥ 6.5 mmol/L.

Table II.  Mortality and cardiovascular morbidity from age 85 years onwards, depending on history of cardiovascular disease and presence of major ECG abnormalities at age 85 years (n = 566).

	History of cardiovascular disease			Major ECG abnormalities
	Yes (n = 284)	No (n = 282)	Hazard ratio	Yes (n = 102)	No (n = 464)	Hazard ratio
Mortality
All-cause	15.9 (13.5–18.4)	8.5 (6.9–10.2)	1.9 (1.5–2.4)	17.0 (12.7–21.3)	11.0 (9.4–12.5)	1.4 (1.1–1.9)
Cardiovascular	7.0 (5.3–8.6)	2.7 (1.8–3.6)	2.7 (1.8–4.1)	7.9 (5.0–10.9)	4.0 (3.1–4.9)	1.8 (1.1–2.8)
Non-cardiovascular	9.0 (7.1–10.8)	5.9 (4.5–7.2)	1.5 (1.1–2.1)	9.1 (5.9–12.2)	6.9 (5.7–8.1)	1.2 (0.8–1.8)
(Non-)fatal MI	4.9 (3.5–6.3)	2.4 (1.5–3.3)	2.1 (1.3–3.6)	3.9 (1.8–6.0)	3.5 (2.6–4.3)	1.1 (0.6–2.1)
(Non-)fatal stroke	5.5 (4.0–6.9)	1.9 (1.1–2.7)	2.7 (1.6–4.9)	5.3 (2.8–7.7)	3.1 (2.3–4.0)	1.6 (0.9–2.8)

Notes: MI = myocardial infarction. Incidence data are presented as point estimates per 100 person years at risk (95% confidence interval); hazard ratios by Cox regression, adjusted for sex, education, and income (95% confidence interval). History of cardiovascular disease (according to general practitioner) included myocardial infarction, stroke, angina pectoris, arrhythmia, peripheral arterial disease, and heart failure. Major ECG abnormalities included prior myocardial infarction (Minnesota Codes 1-1 or 1-2, excluding 1-2-8) and atrial fibrillation (Minnesota Code 8-3-1).

Table III.  Association between the presence of major ECG abnormalities and mortality and cardiovascular morbidity, in strata depending on history of cardiovascular disease at age 85 years (n = 566).

	History of cardiovascular disease
	Yes (n = 284)	No (n = 282)
Major ECG abnormalities yes/no (n/n)	73/211	29/253
Mortality
All-cause	1.2 (0.8–1.6)	1.5 (0.9–2.7)
Cardiovascular	1.4 (0.8–2.3)	1.8 (0.7–4.8)
Non-cardiovascular	1.0 (0.6–1.6)	1.4 (0.7–2.9)
(Non-)fatal myocardial infarction	1.0 (0.5–2.0)	0.8 (0.2–3.3)
(Non-)fatal stroke	1.1 (0.6–2.1)	1.8 (0.5–6.3)

Notes: Data are presented as hazard ratios (95% confidence interval), adjusted for sex, education, and income. History of cardiovascular disease (according to general practitioner) included myocardial infarction, stroke, angina pectoris, arrhythmia, peripheral arterial disease, and heart failure. Major ECG abnormalities included prior myocardial infarction (Minnesota Codes 1-1 or 1-2, excluding 1-2-8) and atrial fibrillation (Minnesota Code 8-3-1).