Impact of lipid lowering therapies after an acute coronary syndrome, applied through telematic consultation, in a cohort of elderly patients

Abstract Funding Acknowledgements Type of funding sources: None. Introduction After Covid-19 pandemic, telematic cardiology consultations are a reality in most developed countries. However, the impact and safety of telemedicine in the elderly population needs to be clarified. Elderly patients may need help to understand and use telemedicine effectively, being thus its benefits differential. Objetives: To assess the impact of lipid lowering therapies, after an acute coronary syndrome (ACS), applied through telematic consultation, in a cohort of elderly patients (≥70 years). Methods We performed a prospective cohort study that consecutively recruited all patients admitted to our centre with an ACS from January 1, 2020 to December 31, 2020. All patients were discharged with high-intensity statins and other currently recommended cardiovascular drugs. Lipid profile was evaluated one month after discharge. Patients were then contacted by phone, treatment was confirmed, and their lipid- lowering therapy was adjusted according to the results of the blood test. This procedure was repeated every month until LDL-c target (≤ 55 mg/dl) was achieved in accordance with current European clinical practice guidelines. Results 346 patients, 32% women, were included. Mean age was 67.3 ± 12.4 years, being 48% ≥ 70 years. Mean follow-up was 17.3 months. Patient’s main characteristics are summarized in Table 1. Comparing both subgroups, patients ≥ 70 years more frequently were women, and had past history of hypertension, diabetes, heart failure and myocardial infarction. There were no differences in clinical presentation at admission (predominantly non-ST elevation myocardial infarction). Patients ≥70 years reached the goal of LDL ≤55 mg/dl in a similar proportion to the younger subgroup (80.1% vs 82.8% p 0.051). There were no statistically significant differences in prescription between groups, with a tendency to a higher prescription of statins and ezetimibe in younger patients (62.8% vs 50.6%, p = 0.05). At follow-up, overall mortality was higher in the subgroup ≥70 years (7.8% vs 1.2%, p 0.026) at the expense of non-cardiovascular mortality (4.8% vs 0.6% p 0.013). There were no differences in cardiovascular mortality, stroke, non-fatal myocardial infarction, or non-urgent angioplasty. Conclusion Lipid lowering therapies applied through telematic consultation in a population ≥ 70 years old after an ACS is as effective and safe as in younger patients. There is however a higher mortality in this subgroup, predominantly because of non-cardiovascular causes.