Acute Coronary Syndromes in the Elderly

• Type of Material: Article
• Authors: Niels Engberding, Emory University; Nanette Wenger, Emory University
• Language: English
• Date: 2017-10-02
• Publisher: F1000Research
• Publication Version: Final Published Version
• Copyright Statement: © 2017 Engberding N and Wenger NK.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.12688/f1000research.11064.1
• Title of Journal or Parent Work: F1000Research
• ISSN: 2046-1402
• Volume: 6
• Start Page: 1791
• End Page: 1791
• Grant/Funding Information: The author(s) declared that no grants were involved in supporting this work.
• Keywords: cardiovascular disease; elderly; acute coronary
• Research Categories: Health Sciences, General; Health Sciences, Medicine and Surgery

Abstract

The clinical evidence for treatment of acute coronary syndrome (ACS) in the elderly is less robust than in patients younger than 75 years. The elderly have the highest incidence of cardiovascular disease and frequently present with ACS. This number can be expected to increase over time because society is aging. Older adults often sustain unfavorable outcomes from ACS because of atypical presentation and delay in recognition. In addition, elderly patients commonly do not receive optimal guideline-directed ACS treatment. Owing to their high baseline risk of ischemic complications, the elderly also fare worse even with optimal ACS treatment as they frequently have more complex coronary disease, more comorbidities, less cardiovascular reserve, and a higher risk of treatment complications. They are also subjected to a broader range of pharmacologic treatment. Treatment complications can be mitigated to some extent by meticulous dose adjustment of antithrombotic and adjunctive therapies. While careful transitions of care and appropriate utilization of post-discharge secondary preventive measures are important in ACS patients of all ages, the elderly are more vulnerable to system errors and thus deserve special attention from the clinician.