Older Adults in the Cardiac Intensive Care Unit: Factoring Geriatric Syndromes in the Management, Prognosis, and Process of Care: A Scientific Statement From the American Heart Association

Longevity is increasing, and more adults are living to the stage of life when age-related biological factors determine a higher likelihood of cardiovascular disease in a distinctive context of concurrent geriatric conditions. Older adults with cardiovascular disease are frequently admitted to cardia...

Full description

Saved in:
Bibliographic Details
Published in:Circulation (New York, N.Y.) Vol. 141; no. 2; p. e6
Main Authors: Damluji, Abdulla A, Forman, Daniel E, van Diepen, Sean, Alexander, Karen P, Page, 2nd, Robert L, Hummel, Scott L, Menon, Venu, Katz, Jason N, Albert, Nancy M, Afilalo, Jonathan, Cohen, Mauricio G
Format: Journal Article
Language:English
Published: United States 14.01.2020
Subjects:
Aged
American Heart Association
Cardiovascular Diseases - pathology
Cardiovascular Diseases - therapy
Decision Making
Delirium - pathology
Disease Management
Energy Intake
Frailty
Geriatric Assessment
Humans
Intensive Care Units
Middle Aged
Multimorbidity
Polypharmacy
Prognosis
Risk Factors
Transitional Care
United States
United States
cognition
aged
multimorbidity
cardiovascular diseases
AHA Scientific Statements
resuscitation orders
frailty
bed rest
decision making
dementia
aging
confusion
delirium
polypharmacy
sarcopenia
ISSN:1524-4539, 1524-4539
Online Access:Get more information
Tags: Add Tag
No Tags, Be the first to tag this record!
Abstract Longevity is increasing, and more adults are living to the stage of life when age-related biological factors determine a higher likelihood of cardiovascular disease in a distinctive context of concurrent geriatric conditions. Older adults with cardiovascular disease are frequently admitted to cardiac intensive care units (CICUs), where care is commensurate with high age-related cardiovascular disease risks but where the associated geriatric conditions (including multimorbidity, polypharmacy, cognitive decline and delirium, and frailty) may be inadvertently exacerbated and destabilized. The CICU environment of procedures, new medications, sensory overload, sleep deprivation, prolonged bed rest, malnourishment, and sleep is usually inherently disruptive to older patients regardless of the excellence of cardiovascular disease care. Given these fundamental and broad challenges of patient aging, CICU management priorities and associated decision-making are particularly complex and in need of enhancements. In this American Heart Association statement, we examine age-related risks and describe some of the distinctive dynamics pertinent to older adults and emerging opportunities to enhance CICU care. Relevant assessment tools are discussed, as well as the need for additional clinical research to best advance CICU care for the already dominating and still expanding population of older adults.
AbstractList Longevity is increasing, and more adults are living to the stage of life when age-related biological factors determine a higher likelihood of cardiovascular disease in a distinctive context of concurrent geriatric conditions. Older adults with cardiovascular disease are frequently admitted to cardiac intensive care units (CICUs), where care is commensurate with high age-related cardiovascular disease risks but where the associated geriatric conditions (including multimorbidity, polypharmacy, cognitive decline and delirium, and frailty) may be inadvertently exacerbated and destabilized. The CICU environment of procedures, new medications, sensory overload, sleep deprivation, prolonged bed rest, malnourishment, and sleep is usually inherently disruptive to older patients regardless of the excellence of cardiovascular disease care. Given these fundamental and broad challenges of patient aging, CICU management priorities and associated decision-making are particularly complex and in need of enhancements. In this American Heart Association statement, we examine age-related risks and describe some of the distinctive dynamics pertinent to older adults and emerging opportunities to enhance CICU care. Relevant assessment tools are discussed, as well as the need for additional clinical research to best advance CICU care for the already dominating and still expanding population of older adults.Longevity is increasing, and more adults are living to the stage of life when age-related biological factors determine a higher likelihood of cardiovascular disease in a distinctive context of concurrent geriatric conditions. Older adults with cardiovascular disease are frequently admitted to cardiac intensive care units (CICUs), where care is commensurate with high age-related cardiovascular disease risks but where the associated geriatric conditions (including multimorbidity, polypharmacy, cognitive decline and delirium, and frailty) may be inadvertently exacerbated and destabilized. The CICU environment of procedures, new medications, sensory overload, sleep deprivation, prolonged bed rest, malnourishment, and sleep is usually inherently disruptive to older patients regardless of the excellence of cardiovascular disease care. Given these fundamental and broad challenges of patient aging, CICU management priorities and associated decision-making are particularly complex and in need of enhancements. In this American Heart Association statement, we examine age-related risks and describe some of the distinctive dynamics pertinent to older adults and emerging opportunities to enhance CICU care. Relevant assessment tools are discussed, as well as the need for additional clinical research to best advance CICU care for the already dominating and still expanding population of older adults.
Longevity is increasing, and more adults are living to the stage of life when age-related biological factors determine a higher likelihood of cardiovascular disease in a distinctive context of concurrent geriatric conditions. Older adults with cardiovascular disease are frequently admitted to cardiac intensive care units (CICUs), where care is commensurate with high age-related cardiovascular disease risks but where the associated geriatric conditions (including multimorbidity, polypharmacy, cognitive decline and delirium, and frailty) may be inadvertently exacerbated and destabilized. The CICU environment of procedures, new medications, sensory overload, sleep deprivation, prolonged bed rest, malnourishment, and sleep is usually inherently disruptive to older patients regardless of the excellence of cardiovascular disease care. Given these fundamental and broad challenges of patient aging, CICU management priorities and associated decision-making are particularly complex and in need of enhancements. In this American Heart Association statement, we examine age-related risks and describe some of the distinctive dynamics pertinent to older adults and emerging opportunities to enhance CICU care. Relevant assessment tools are discussed, as well as the need for additional clinical research to best advance CICU care for the already dominating and still expanding population of older adults.
Author van Diepen, Sean
Katz, Jason N
Afilalo, Jonathan
Forman, Daniel E
Menon, Venu
Hummel, Scott L
Alexander, Karen P
Cohen, Mauricio G
Damluji, Abdulla A
Page, 2nd, Robert L
Albert, Nancy M
Author_xml – sequence: 1
  givenname: Abdulla A
  surname: Damluji
  fullname: Damluji, Abdulla A
– sequence: 2
  givenname: Daniel E
  surname: Forman
  fullname: Forman, Daniel E
– sequence: 3
  givenname: Sean
  surname: van Diepen
  fullname: van Diepen, Sean
– sequence: 4
  givenname: Karen P
  surname: Alexander
  fullname: Alexander, Karen P
– sequence: 5
  givenname: Robert L
  surname: Page, 2nd
  fullname: Page, 2nd, Robert L
– sequence: 6
  givenname: Scott L
  surname: Hummel
  fullname: Hummel, Scott L
– sequence: 7
  givenname: Venu
  surname: Menon
  fullname: Menon, Venu
– sequence: 8
  givenname: Jason N
  surname: Katz
  fullname: Katz, Jason N
– sequence: 9
  givenname: Nancy M
  surname: Albert
  fullname: Albert, Nancy M
– sequence: 10
  givenname: Jonathan
  surname: Afilalo
  fullname: Afilalo, Jonathan
– sequence: 11
  givenname: Mauricio G
  surname: Cohen
  fullname: Cohen, Mauricio G
BackLink https://www.ncbi.nlm.nih.gov/pubmed/31813278$$D View this record in MEDLINE/PubMed
BookMark eNpNkF9LwzAQwIMozn_fQOQefXDaS9ql9a0Mp4OJou55pOl1RtpEk0zwu_nhrHOKB8fljl9-B7fPtq2zxNgxJueII7wYTx_Ok_8hU9xie5jxdJhmotj-9x6w_RBeemYkZLbLBgJzFFzme-zzrq3JQ1mv2hjAWIjPBGPla6M0TG0kG8z7ekIwtyZewkTp6LyxS7gmb1T0RsPjh6296-jPcKusWlJHNp7BvXdL64IJZ6Bs_d1qCgFcs7ZeQgmP2vSkab5NUcX1P5j0wrWr7Po9Wlm4IeUjlCE43e81zh6ynUa1gY429YDNJ1dP45vh7O56Oi5nQ52OJA6FpLQRmGFV1LqqtEgk8ipDWRRcyz4VKpEltVZEmOsmSSjX2GOYV5ilBT9gpz_eV-_eVhTiojNBU9sqS24VFlxwnieykKMePdmgq6qjevHqTaf8x-L34vwLEz6G4A
CitedBy_id crossref_primary_10_1161_CIRCULATIONAHA_123_064071
crossref_primary_10_1002_clc_23915
crossref_primary_10_1007_s11883_024_01203_9
crossref_primary_10_1016_j_steroids_2025_109587
crossref_primary_10_62347_DGQV8894
crossref_primary_10_1016_j_amjcard_2024_01_030
crossref_primary_10_1016_j_ijcard_2025_133448
crossref_primary_10_1016_j_critrevonc_2023_104117
crossref_primary_10_1093_europace_euaf076
crossref_primary_10_1016_j_cardfail_2022_12_001
crossref_primary_10_1161_CIR_0000000000000985
crossref_primary_10_1016_j_jacc_2025_02_002
crossref_primary_10_1007_s40266_024_01139_4
crossref_primary_10_1161_CIR_0000000000001112
crossref_primary_10_1097_FJC_0000000000001680
crossref_primary_10_1016_j_ahj_2023_12_018
crossref_primary_10_1016_j_jacc_2024_11_003
crossref_primary_10_1111_jgs_18228
crossref_primary_10_2147_CIA_S308893
crossref_primary_10_5114_ait_2021_108084
crossref_primary_10_1016_j_amjmed_2022_01_046
crossref_primary_10_56294_hl2025603
crossref_primary_10_1002_ehf2_12995
crossref_primary_10_1080_14779072_2025_2528922
crossref_primary_10_15829_1560_4071_2024_5740
crossref_primary_10_1007_s40520_025_03108_2
crossref_primary_10_1016_j_acvd_2025_02_007
crossref_primary_10_1016_j_ahj_2020_03_021
crossref_primary_10_1038_s41598_023_48418_5
crossref_primary_10_1136_openhrt_2023_002418
crossref_primary_10_1016_j_rccl_2025_06_003
crossref_primary_10_1161_CIRCULATIONAHA_124_068203
crossref_primary_10_1016_j_ijcard_2023_131578
crossref_primary_10_1161_CIRCRESAHA_125_325705
crossref_primary_10_1016_j_jacadv_2022_100070
crossref_primary_10_1016_j_amjmed_2020_09_057
crossref_primary_10_1016_j_ejim_2025_03_028
crossref_primary_10_1161_JAHA_123_033594
crossref_primary_10_1016_j_amjcard_2020_08_036
crossref_primary_10_1016_j_cjca_2025_01_031
crossref_primary_10_1371_journal_pone_0243810
crossref_primary_10_1053_j_jvca_2020_08_034
crossref_primary_10_1186_s13054_021_03750_y
crossref_primary_10_3390_jcm11195663
crossref_primary_10_1002_ncp_10540
crossref_primary_10_1016_j_jacadv_2024_101358
crossref_primary_10_1053_j_semtcvs_2022_08_017
crossref_primary_10_1016_j_cnc_2023_05_012
crossref_primary_10_1016_j_hrtlng_2024_08_011
crossref_primary_10_15829_1560_4071_2021_4524
crossref_primary_10_1016_j_amjcard_2023_12_062
crossref_primary_10_1016_j_cardfail_2021_09_001
crossref_primary_10_1161_CIR_0000000000001214
crossref_primary_10_1016_j_ijnurstu_2023_104582
crossref_primary_10_1016_j_ccl_2022_05_001
crossref_primary_10_1111_jan_15998
crossref_primary_10_1161_CIR_0000000000001334
crossref_primary_10_1161_CIRCULATIONAHA_122_059935
crossref_primary_10_1016_j_amjcard_2021_06_038
crossref_primary_10_3390_app14156726
crossref_primary_10_2147_IJGM_S372158
crossref_primary_10_1111_jgs_16822
crossref_primary_10_1016_j_cnc_2020_10_001
crossref_primary_10_1186_s12877_023_04105_8
crossref_primary_10_1136_openhrt_2025_003302
crossref_primary_10_3390_jcm12165233
crossref_primary_10_3389_fped_2020_00275
crossref_primary_10_1016_j_ccc_2020_08_006
crossref_primary_10_3390_jcm12072603
crossref_primary_10_3390_nu15173710
crossref_primary_10_1016_j_hlc_2023_05_023
crossref_primary_10_1016_j_jacadv_2024_100877
crossref_primary_10_3390_healthcare9111560
crossref_primary_10_36290_vnl_2023_029
crossref_primary_10_1007_s00134_024_07546_w
crossref_primary_10_1093_eurheartj_ehab468
crossref_primary_10_2196_60885
crossref_primary_10_1016_j_ahj_2021_11_021
crossref_primary_10_1007_s00134_025_07794_4
crossref_primary_10_1093_ehjcvp_pvac005
crossref_primary_10_3389_fcvm_2024_1362791
crossref_primary_10_1007_s44179_022_00093_z
crossref_primary_10_1016_j_gerinurse_2025_103436
crossref_primary_10_31083_RCM37636
crossref_primary_10_1161_CIR_0000000000001300
crossref_primary_10_1016_j_amjmed_2020_09_035
crossref_primary_10_1093_eurheartj_ehab391
crossref_primary_10_1136_bmj_n1593
crossref_primary_10_2147_CIA_S365968
crossref_primary_10_1016_j_jcin_2022_12_008
crossref_primary_10_1016_S0140_6736_24_01818_X
crossref_primary_10_1016_j_jacadv_2023_100389
crossref_primary_10_1016_j_jbmt_2023_05_004
crossref_primary_10_1016_j_ijcard_2025_133294
crossref_primary_10_1016_j_hfc_2022_08_011
crossref_primary_10_1161_CIRCINTERVENTIONS_121_011669
ContentType Journal Article
CorporateAuthor American Heart Association Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing
CorporateAuthor_xml – name: American Heart Association Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing
DBID CGR
CUY
CVF
ECM
EIF
NPM
7X8
DOI 10.1161/CIR.0000000000000741
DatabaseName Medline
MEDLINE
MEDLINE (Ovid)
MEDLINE
MEDLINE
PubMed
MEDLINE - Academic
DatabaseTitle MEDLINE
Medline Complete
MEDLINE with Full Text
PubMed
MEDLINE (Ovid)
MEDLINE - Academic
DatabaseTitleList MEDLINE - Academic
MEDLINE
Database_xml – sequence: 1
  dbid: NPM
  name: PubMed
  url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
  sourceTypes: Index Database
– sequence: 2
  dbid: 7X8
  name: MEDLINE - Academic
  url: https://search.proquest.com/medline
  sourceTypes: Aggregation Database
DeliveryMethod no_fulltext_linktorsrc
Discipline Medicine
Anatomy & Physiology
EISSN 1524-4539
ExternalDocumentID 31813278
Genre Journal Article
GeographicLocations United States
GeographicLocations_xml – name: United States
GrantInformation_xml – fundername: NHLBI NIH HHS
  grantid: K23 HL153771
GroupedDBID ---
.-D
.3C
.XZ
.Z2
01R
0R~
0ZK
18M
1J1
29B
2FS
2WC
354
40H
4Q1
4Q2
4Q3
53G
5GY
5RE
5VS
6PF
71W
77Y
7O~
AAAAV
AAAXR
AAGIX
AAHPQ
AAIQE
AAJCS
AAMOA
AAMTA
AAQKA
AARTV
AASCR
AASOK
AASXQ
AAUEB
AAWTL
AAXQO
ABASU
ABBUW
ABDIG
ABJNI
ABOCM
ABPMR
ABQRW
ABVCZ
ABXVJ
ABZAD
ACDDN
ACEWG
ACGFO
ACGFS
ACIJW
ACILI
ACLDA
ACOAL
ACRKK
ACWDW
ACWRI
ACXJB
ACXNZ
ADBBV
ADCYY
ADGGA
ADHPY
AE3
AE6
AEBDS
AENEX
AFCHL
AFDTB
AFEXH
AFSOK
AFUWQ
AGINI
AHMBA
AHOMT
AHQNM
AHRYX
AHVBC
AIJEX
AINUH
AJCLO
AJIOK
AJNWD
AJZMW
AKCTQ
AKULP
ALKUP
ALMA_UNASSIGNED_HOLDINGS
ALMTX
AMJPA
AMKUR
AMNEI
AOHHW
ASPBG
AVWKF
AWKKM
AYCSE
AZFZN
BAWUL
BOYCO
BQLVK
BYPQX
C45
CGR
CS3
CUY
CVF
DIK
DIWNM
DU5
E3Z
EBS
ECM
EEVPB
EIF
ERAAH
EX3
F2K
F2L
F2M
F2N
F5P
FCALG
GNXGY
GQDEL
GX1
H0~
HLJTE
HZ~
IKREB
IKYAY
IN~
IPNFZ
JF9
JG8
JK3
K-A
K-F
K8S
KD2
KMI
KQ8
L-C
L7B
N9A
NPM
N~7
N~B
O9-
OAG
OAH
OBH
OCB
ODA
ODMTH
OGEVE
OHH
OHYEH
OJAPA
OK1
OL1
OLB
OLG
OLH
OLU
OLV
OLW
OLY
OLZ
OPUJH
OVD
OVDNE
OVIDH
OVLEI
OVOZU
OWBYB
OWU
OWV
OWW
OWX
OWY
OWZ
OXXIT
P2P
PQQKQ
RAH
RHF
RIG
RLZ
S4R
S4S
T8P
TEORI
TR2
TSPGW
UPT
V2I
VVN
W2D
W3M
W8F
WH7
WOQ
WOW
X3V
X3W
XXN
XYM
YFH
YOC
YSK
YYM
YZZ
ZFV
ZY1
~H1
7X8
AAFWJ
ABPXF
ABXYN
ABZZY
ACDOF
ACZKN
ADKSD
ADSXY
AFBFQ
AFMBP
AFNMH
AHQVU
AOQMC
ID FETCH-LOGICAL-c4671-37e4f3151b9dcbbc30712b517992c792ca1a350dcaee18cf00e8c1c3018b15492
IEDL.DBID 7X8
ISICitedReferencesCount 118
ISICitedReferencesURI http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=00003017-202001140-00013&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D
ISSN 1524-4539
IngestDate Thu Oct 02 11:22:28 EDT 2025
Wed Feb 19 02:26:18 EST 2025
IsPeerReviewed true
IsScholarly true
Issue 2
Keywords cognition
aged
multimorbidity
cardiovascular diseases
AHA Scientific Statements
resuscitation orders
frailty
bed rest
decision making
dementia
aging
confusion
delirium
polypharmacy
sarcopenia
Language English
LinkModel DirectLink
MergedId FETCHMERGED-LOGICAL-c4671-37e4f3151b9dcbbc30712b517992c792ca1a350dcaee18cf00e8c1c3018b15492
Notes ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
PMID 31813278
PQID 2322807976
PQPubID 23479
ParticipantIDs proquest_miscellaneous_2322807976
pubmed_primary_31813278
PublicationCentury 2000
PublicationDate 2020-01-14
20200114
PublicationDateYYYYMMDD 2020-01-14
PublicationDate_xml – month: 01
  year: 2020
  text: 2020-01-14
  day: 14
PublicationDecade 2020
PublicationPlace United States
PublicationPlace_xml – name: United States
PublicationTitle Circulation (New York, N.Y.)
PublicationTitleAlternate Circulation
PublicationYear 2020
References 32921612 - J Cardiothorac Vasc Anesth. 2021 Feb;35(2):363-365
References_xml – reference: 32921612 - J Cardiothorac Vasc Anesth. 2021 Feb;35(2):363-365
SSID ssj0006375
Score 2.6122742
SecondaryResourceType review_article
Snippet Longevity is increasing, and more adults are living to the stage of life when age-related biological factors determine a higher likelihood of cardiovascular...
SourceID proquest
pubmed
SourceType Aggregation Database
Index Database
StartPage e6
SubjectTerms Aged
American Heart Association
Cardiovascular Diseases - pathology
Cardiovascular Diseases - therapy
Decision Making
Delirium - pathology
Disease Management
Energy Intake
Frailty
Geriatric Assessment
Humans
Intensive Care Units
Middle Aged
Multimorbidity
Polypharmacy
Prognosis
Risk Factors
Transitional Care
United States
Title Older Adults in the Cardiac Intensive Care Unit: Factoring Geriatric Syndromes in the Management, Prognosis, and Process of Care: A Scientific Statement From the American Heart Association
URI https://www.ncbi.nlm.nih.gov/pubmed/31813278
https://www.proquest.com/docview/2322807976
Volume 141
WOSCitedRecordID wos00003017-202001140-00013&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D
hasFullText
inHoldings 1
isFullTextHit
isPrint
link http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV3da9swEBfrB6Uv3dbPdFu5QelTRS1bieW8jBCWtQ_NwtpC3oIkS5CH2mndFvq_9Y_rnaI0eykMZrAfjHUYdLr7ne70O8aOM9uRpbOap950uCxTzZWxKUftSUrlCvTYJjSbyIdDNR4Xo7jh1sSyyoVNDIa6rC3tkZ-h5yfiFvSeP2Z3nLpGUXY1ttBYYWsZQhnS6ny8ZAvvZIFoF12U5LKdFfHoHIKcs_7Fnzl14eLKpXgfZAZnM_j4v7_5iW1FmAm9uV58Zh9ctc12ehWG2LfPcAKh8DPsqG-zjcuYX99hL7-paTf0iJSjgWkFCA-hH5TIwlu1O71xQGi1C4PQrwf9H_wiXSa-f7iKLAhvEpY1Nqcwuq-ptm_anIKuSogHFaD2QWoXehDMTShhggCFaRwMUGCQtUgxwTmu0Qf4S7122c3g53X_nMf-DtyieRZo25z0GUIOU5TWGIvmRqSGOMOK1OZ4a6GzdlJa7ZxQ1ieJU1bgZ0KZwCy3x1arunIHDDJvHAY-PjGJldRztN32ypdSZtJbrXSLfV9M1wTXDyVFdOXqx2aynLAW25_P-WQ2J_qYoL3DYD1Xh_8w-gvbTCkUTwQX8itb82g93De2bp8eps39UVBMfA5Hl6-kme4x
linkProvider ProQuest
openUrl ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Older+Adults+in+the+Cardiac+Intensive+Care+Unit%3A+Factoring+Geriatric+Syndromes+in+the+Management%2C+Prognosis%2C+and+Process+of+Care%3A+A+Scientific+Statement+From+the+American+Heart+Association&rft.jtitle=Circulation+%28New+York%2C+N.Y.%29&rft.au=Damluji%2C+Abdulla+A&rft.au=man%2C+Daniel+E&rft.au=van+Diepen%2C+Sean&rft.au=Alexander%2C+Karen+P&rft.date=2020-01-14&rft.issn=1524-4539&rft.eissn=1524-4539&rft.volume=141&rft.issue=2&rft.spage=e6&rft_id=info:doi/10.1161%2FCIR.0000000000000741&rft.externalDBID=NO_FULL_TEXT
thumbnail_l http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1524-4539&client=summon
thumbnail_m http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1524-4539&client=summon
thumbnail_s http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1524-4539&client=summon