Voinarovska G. Prognostic value of comorbid conditions and hypoxia tolerance reduction in the elderly and senile patients with coronary artery disease

The thesis presents both theoretical generalization and solution of the topical scientific and practical problem in internal medicine: clarification of the prognostic value of comorbid conditions and hypoxia tolerance reduction as well as development of methods for lifetime prognosis in the older patients with coronary artery disease (CAD). Among the main comorbid conditions in older patients with CAD the dyslipidemia and arterial hypertension (AH) were most often detected, less often – COPD and diabetes mellitus (DM). The most common combinations of comorbid conditions in older patients with CAD were dyslipidemia + one of the other comorbidities (AH, DM or COPD). It was established that in deceased older patients with CAD there was a high frequency of detection of severe stages of AH and dyslipidemia, a slightly less – COPD and DM. Among the deceased, the rate of three simultaneous comorbid conditions was 38.1 % (versus 29.8 % in survivors, p < 0.01), and the rate of four simultaneous comorbid conditions was 37.3% (versus 29.3 % in survivors, p < 0.01). A model of the probability of survival up to 80 years in older age group of patients with CAD depending on the presence of the comorbid conditions was developed. It was found that the largest contribution to lifetime shortening had AH and DM, and slightly less – COPD and dyslipidemia. A model of life span prediction in the older patients with CAD has been developed, taking into account the informative indices of comorbid conditions. The impact on the shortening of residual years of life in older patients with CAD was most marked at the age range 72–83 years for AH, 63–83 years for DM, 70–80 years for COPD and 67–78 years for dyslipidemia. It was found that patients with CAD and reduced hypoxia tolerance had more comorbid conditions and significantly shorter life expectancy. In older patients with CAD the disorders in functional state of the cardiorespiratory system of the body were associated with reduced hypoxia tolerance. A mathematical model for predicting the probability of reduced hypoxia tolerance in the older patients with CAD and comorbidities was developed. Herewith the COPD presence in older patients with CAD increases the probability of developing a reduced hypoxia tolerance by 1.49 times, and AH – by 1.35 times. DM by 1.29 times and dyslipidemia by 1.20 times increases the risk of reduced hypoxia tolerance in older patients with CAD to a lesser extent.