Highlights of the statement:
- A new scientific statement from the American Heart Association provides updated information on how age affects the diagnosis and treatment of heart attacks in people age 75 and older.
- Changes in the cardiovascular system associated with normal aging and noncardiac conditions that become more common with age should be considered when planning treatment and follow-up for a heart attack.
- Adequate care for the elderly is becoming increasingly important as the proportion of elderly people in the population continues to increase.
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DALLAS, Dec. 12, 2022 -- In people 75 and older, age-related changes in general health as well as in the heart and blood vessels warrant attention and likely changes in the treatment of heart attacks and heart disease, according to a new study from American Heart Today . The society's published scientific advice is published in the society's main peer-reviewed journalTraffic.
The new statement, Management of Acute Coronary Syndrome (ACS) in the Older Adult Population, highlights current evidence to help doctors better care for patients over 75 years of age. According to the statement, 30-40% of those hospitalized with ACS are 75 years or older. ACS includedHeart attackIIt is useful for angina pectoris(heart-related chest pain).
The statement is an update of one2007 American Heart Association Statementfor the treatment of heart attacks in the elderly.
Clinical practice guidelines are based on research from clinical trials. "However, older adults are often excluded from clinical trials because their health care needs are more complex than those of younger patients," said Abdulla A. Damluji, M.D., Ph.D., FAHA, Chair of the Scientific Opinion Writing Committee and Director of the Inova Center of Outcomes Research in Fairfax, Virginia and associate professor of medicine at the Johns Hopkins School of Medicine in Baltimore.
"Elderly patients have more pronounced anatomical changes and more severe functional limitations and are more likely to have additional health problems unrelated to heart disease," Damluji said. "These include frailty, other chronic conditions (treated with multiple drugs), physical dysfunction, cognitive decline, and/or urinary incontinence—and these are not routinely investigated in association with ACS."
Normal aging and age-related changes in the heart and blood vessels
Cardiovascular changes that occur with normal aging increase the likelihood of ACS and can make diagnosis and treatment more complex: large arteries become stiffer; The heart muscle often works harder but pumps less efficiently; Blood vessels are less flexible and less responsive to changes in the heart's oxygen demand; and there is an increased tendency to form blood clots. Sensory decline due to aging can also lead to auditory, visual and pain sensations. Kidney function also declines with age: Over a third of people aged 65 and older suffer from chronic kidney disease. These changes should be considered when diagnosing and treating ACS in older adults.
These considerations include:
- ACS is more common in older adults without chest pain and may present with symptoms such as shortness of breath, fainting, or sudden confusion.
- Measuring the levels of the enzyme troponin in the blood is a standard test for diagnosing heart attacks in younger people. However, troponin levels may be higher in older people, especially those with kidney disease and stiffened heart muscle. Evaluating patterns of rise and fall in troponin levels may be more helpful in diagnosing heart attacks in older adults.
- Age-related changes in metabolism, weight and muscle mass may necessitate a different choice of antiplatelet agents to reduce the risk of bleeding.
- As kidney function declines, the risk of kidney damage increases, especially when contrast agents are used in imaging studies and imaging procedures.
- Although many physicians avoid cardiac rehabilitation in vulnerable patients, they often benefit most from it.
- When moving from the hospital to an ambulatory care facility, it is especially important to ensure that medications and other care continue when the elderly are vulnerable to frailty, decay, and complications during these transitions.
Multiple medical conditions and medications
As people get older, they are often diagnosed with health problems that can be exacerbated by ACS or complicate an existing ACS. When treating these chronic conditions, the number of medications prescribed can lead to unwanted interactions, or medications used to treat one condition can worsen another condition.
"Geriatric syndromes and the complexity of their treatment can compromise the effectiveness of treatments for ACS, as well as the resilience of older adults to survive and recover," Damluji said. "A detailed record of all medications—including supplements and over-the-counter medications—is essential, ideally in consultation with a pharmacist with geriatric expertise."
For older adults, an individualized and patient-centered approach to ACS care that takes into account coexisting conditions and the need for input from multiple specialists is most appropriate. Ideally, the multidisciplinary teams caring for older adults with ACS include cardiologists, surgeons, geriatricians, family physicians, nutritionists, pharmacists, cardiac rehabilitation staff, social workers, nurses, and family members.
In addition, people with cognitive problems and limited mobility can benefit from a simplified medication schedule, requiring fewer doses per day and a 90-day supply of medication, meaning fewer refills. Monitoring symptom burden, functional status, and quality of life during post-discharge follow-up is important to understand the patient's progress toward their goals of care and gauge the potential for improvement.
Patient preferences and life expectancy
Older adults vary widely in their degree of independence, physical or cognitive limitations, life expectancy, and goals for the future. The goals of care for the elderly with ACS should go beyond clinical outcomes (such as bleeding, stroke, recurrent heart attack, or the need for repeat procedures to reopen the arteries). Goals that focus on quality of life, ability to live independently, and/or return to their previous lifestyle or living environment are important when planning care for older adults with ACS. Additionally, Do Not Resuscitate (DNR) instructions should be discussed before any surgery or procedure.
- Although the risk is greater, bypass surgery, or surgery to reopen a blocked artery, is beneficial for certain older adults with ACS.
- If invasive treatment is chosen, a DNR setup may need to be suspended for the duration of the procedure.
- If invasive treatment is not chosen, palliative care can help relieve symptoms, improve quality of life and provide psychosocial support.
- Important measures of quality care include measurable goals, such as: B. days at home and relief of pain and discomfort.
This scientific statement was prepared by the volunteer group of authors on behalf of the Committee on Cardiovascular Disease in the Elderly of the American Heart Association of the Council on Clinical Cardiology; Cardiovascular and Stroke Council; the Cardiovascular Radiology and Interventional Council; and the Lifestyle and Cardiometabolic Health Council. Scientific advice from the American Heart Association promotes greater awareness of cardiovascular disease and stroke and helps facilitate informed health care decisions. Scientific opinions provide an overview of what is currently known about a topic and areas where further research is needed. While scientific opinions contribute to the development of guidelines, they do not provide treatment recommendations. The American Heart Association's guidelines contain the association's official recommendations for clinical practice.
Co-authors are Vice President Daniel E. Forman, M.D., FAHA; Tracy Y. Wang, MD, MHS, M.Sc., FAHA; Joanna Chikwe, MD, FAHA; Vijay Kunadian, MBBS, MD; Michael W. Rich, MD; Bessie A. Young, MD, MPH; Robert L. Side II, Pharm.D., M.S.P.H., FAHA; Holli A. DeVon, Ph.D., RN., FAHA; and Karen P. Alexander, MD, FAHA. The authors' details are given in the manuscript.
The association mainly receives funds from private individuals. Foundations and corporations (including pharmaceutical, appliance, and other companies) also make donations and sponsor specific association programs and events. The Society has a strict policy to prevent these conditions from influencing the scientific content. Earnings from pharmaceutical and biotech companies, device manufacturers, and health insurers, as well as general financial information from the association are availableHer.
- Available multimedia content can be found in the right column of the publication linkhttps://newsroom.heart.org/news/hearts-and-bodies-change-with-age-heart-disease-treatments-may-need-to-change-too?preview=1c44c89a17745d77f58b8c88a413232e
- Spanish press release
- After December 12, watchManuscript online.
- AHA press release:Ten or more drugs commonly prescribed to elderly patients with heart failure are cause for concern(October 2020)
- AHA pressemeddelelse:For geriatric patients, treatment of more than just the heart is essential(december 2019)
- Follow AHA/ASA news on Twitter@HartNews
Om American Heart Association
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