Acute Coronary Syndrome in the Elderly

Shanmugasundaram, Madhan; Alpert, Joseph S.

doi:10.1002/clc.20623

Cited by 16 publications

(7 citation statements)

References 52 publications

(28 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Elderly patients often present with comorbid kidney disease that may magnify their risk for drug-related adverse events. 5 Rates of blood transfusions for bleeding complications rise with age in patients who are treated either noninvasively or invasively. 6 Particularly among individuals treated with percutaneous coronary intervention, advanced age has been directly associated with contrastinduced nephropathy, stroke/transient ischemic attack, and access-site and other vascular complications.…”

Section: Influence Of Age On Acs Presentation and Outcomesmentioning

confidence: 99%

B‐type Natriuretic Peptides in Acute Coronary Syndromes: Implications in an Aging Population

Krim

Vivo

Lemos³

2012

Clinical Cardiology

View full text Add to dashboard Cite

B-type natriuretic peptide (BNP) and N-terminal-proBNP (NT-proBNP) are increasingly recognized as prognostic markers in patients with acute coronary syndrome (ACS). The need for novel and more effective tools for risk assessment cannot be more emphasized than in older patients with ACS given their atypical presentation, multiple comorbidities, and higher risk for mortality and morbidity. Accurate interpretation of B-type NP values in older patients with ACS, however, may be confounded by several aging-related physiologic changes. Advanced age, reduction in body mass, and kidney function and anemia have been associated with higher BNP and NT-proBNP concentrations, and may create challenges with interpreting NP levels in the elderly. This review highlights the need to better understand the physiology of BNP and NT-proBNP in older individuals and their prognostic value in older patients with ACS. IntroductionThe prognostic role of B-type natriuretic peptide (BNP) and N-terminal-proBNP (NT-proBNP) in acute coronary syndromes (ACS) remains the subject of vigorous investigation reflecting the growing interest in improving risk stratification strategies for affected patients. While a compelling body of evidence demonstrates that these biomarkers independently predict adverse outcomes, a few issues of uncertainty limit their routine use in clinical decision making. One is the question of whether existing evidence can be extrapolated to the older population. This is an important issue as approximately 82% of deaths from coronary artery disease (CAD) occur in individuals age 65 or older. 1 Fundamental to examining the value of BNP and NT-proBNP in older persons with CAD is identifying aging-related factors that may influence their levels. This review summarizes current literature describing the value of these biomarkers in older patients with ACS. The relationship of BNP and NT-proBNP with advanced age and its associated physiologic alterations is also reviewed.

show abstract

Section: Influence Of Age On Acs Presentation and Outcomesmentioning

confidence: 99%

B‐type Natriuretic Peptides in Acute Coronary Syndromes: Implications in an Aging Population

Krim

Vivo

Lemos³

2012

Clinical Cardiology

View full text Add to dashboard Cite

show abstract

“…Although men are at greater risk of developing CHD than premenopausal women, sex differences in the risk of acute coronary disease narrow after menopause. Furthermore, the majority of published studies have shown that women experience higher death rates after AMI than men, irrespective of age, and that women are more likely to experience serious complications of AMI than men 5,6 …”

mentioning

confidence: 99%

Exclusion of Older Adults and Women from Recent Trials of Acute Coronary Syndromes

Dodd

Saczynski

Zhao

et al. 2011

Journal of the American Geriatrics Society

View full text Add to dashboard Cite

Objective The prevalence of coronary heart disease increases with advancing age. However, there is evidence that older patients and women were underrepresented in coronary heart disease clinical trials prior to the year 2000. To determine whether the participation of the elderly and women in published clinical trials has increased during recent years, we conducted a review of recent clinical trials of acute coronary syndromes (ACS). Design and Measurements We conducted a search of MEDLINE and the Cochrane Central Register of Controlled Trials to identify clinical trials of ACS published from May, 2007 to May, 2009. Trials were excluded if they enrolled <50 patients, were sub-studies of previously published trials, or initiated treatment more than 3 weeks after the acute cardiac event. Results Eighty trials, enrolling a total of 68,016 subjects, met our pre-established criteria. Nearly 30% (n= 23) had explicit exclusion criteria based on age. Only 13.8% of study participants were ≥75 years and 27.7% of subjects were women. These percentages remain below the representation of all U.S. adults experiencing an ACS in recent years who were ≥75 years of age (41.9%) or women (41.5%). The average age of all study participants was 61.6 years (SD=3.8). There was a significant association between the mean age of a study participant and the proportion of women enrolled in the trial. Conclusion Older adults and women remain underrepresented in recent clinical trials of patients hospitalized with an ACS. These exclusions may hinder efforts to inform evidence-based clinical decision-making in these high-risk patient populations.

show abstract

“…Acute heart failure was significantly more frequent in elderly. Acute coronary syndrome is more frequent in the elderly than in the general population and is associated with very high morbidity and mortality [18,19]. Prevention of cardiovascular diseases was probably underused in our elderly patients, even if it is efficient, and that could explain also complications and hospitalization in ICU [20].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Elderly Patients Hospitalized in Intensive Care Unit for Severs Medical Illnesses

Nechba¹

2013

SJPH

View full text Add to dashboard Cite

Objectives: This study was made to identify the epidemiological data of elderly patients (over 65 years of age) vs. younger patients (< 65 years) requiring admission to the intensive care unit for severs medical illnesses. Design and patients: We conducted an analysis of a prospective observational study of 106 adults admitted to the intensive care unit for severs medical illnesses, from January 2010 to January 2012. Patients admitted to the intensive care unit for surgical illnesses were excluded. Setting: A 6-bed polyvalent intensive care unit in a regional hospital. Results: The study group included 31(29%) elderly patients (≥65 years of age) and 75 (71%) young patients (<65 years of age) (n=106). Elderly patients tended to have a higher simplified acute physiology score version II in admission (36 vs 21, p<0,001). There were several epidemiological differences between the two groups: Chronic diseases were more frequent in elderly patients than in younger one (diabetes (55% vs 20%; p<0,001), high blood pressure (45% vs 13%; p<0,001) and heart diseases (48% vs 19%; p=0,002). Elderly patients were significantly more hospitalized for delirium comparing to younger one (87% vs 64%; p=0,017), but dyspnea was less percepted by elderly patients 29% vs 55% for younger patients, p=0,016. Acute respiratory distress syndrome, acute heart failure, acute kidney injury, were all more frequent in elderly patients respectively (p= 0,006, p=0,014, p=0,005). The incidence of death was 37% for all patients and it was similar between the two groups (p=0,251). Conclusion: The identification of epidemiology of older patients hospitalized in intensive care unit for severs medical illnesses will help to develop qualified practice. Further studies are needed to better characterize those elderly individuals who may be at the highest risk of complications.

show abstract

Acute Coronary Syndrome in the Elderly

Cited by 16 publications

References 52 publications

B‐type Natriuretic Peptides in Acute Coronary Syndromes: Implications in an Aging Population

B‐type Natriuretic Peptides in Acute Coronary Syndromes: Implications in an Aging Population

Exclusion of Older Adults and Women from Recent Trials of Acute Coronary Syndromes

Epidemiology of Elderly Patients Hospitalized in Intensive Care Unit for Severs Medical Illnesses

Contact Info

Product

Resources

About