Management and Care of Older Cardiac Patients

Damluji, Abdulla A.; Ramireddy, Archana; Forman, Daniel E.

doi:10.1016/b978-0-12-809657-4.64094-2

Cited by 10 publications

(13 citation statements)

References 147 publications

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“…The population of older adults is rapidly expanding and is in fact the fastest growing sector of the United States census (1,2). Although life expectancy is increasing, and there have been significant therapeutic advances, the burden of cardiovascular disease among older adults remains high.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous Coronary Intervention in Older Patients With ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock

Damluji

Bandeen‐Roche

Berkower

et al. 2019

Journal of the American College of Cardiology

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Section: Introductionmentioning

confidence: 99%

Percutaneous Coronary Intervention in Older Patients With ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock

Damluji

Bandeen‐Roche

Berkower

et al. 2019

Journal of the American College of Cardiology

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“…Multimorbidity, defined as ≥2 chronic conditions, is ubiquitous in older adults with CVD. 17 In Medicare fee-for-service beneficiaries with ischemic heart disease, 48% have ≥5 comorbid conditions, 32% have 3 to 4 coexisting conditions, 17.5% have 1 to 2 other conditions, and only ≈2.5% have isolated ischemic heart disease. 25 Thus, ACS in older patients almost always occurs in the context of multiple comorbidities, many of which may intersect with the approach to treatment.…”

Section: Multimorbidity and Polypharmacymentioning

confidence: 99%

Management of Acute Coronary Syndrome in the Older Adult Population: A Scientific Statement From the American Heart Association

Damluji¹,

Forman²,

Wang³

et al. 2023

Circulation

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Diagnostic and therapeutic advances during the past decades have substantially improved health outcomes for patients with acute coronary syndrome. Both age-related physiological changes and accumulated cardiovascular risk factors increase the susceptibility to acute coronary syndrome over a lifetime. Compared with younger patients, outcomes for acute coronary syndrome in the large and growing demographic of older adults are relatively worse. Increased atherosclerotic plaque burden and complexity of anatomic disease, compounded by age-related cardiovascular and noncardiovascular comorbid conditions, contribute to the worse prognosis observed in older individuals. Geriatric syndromes, including frailty, multimorbidity, impaired cognitive and physical function, polypharmacy, and other complexities of care, can undermine the therapeutic efficacy of guidelines-based treatments and the resiliency of older adults to survive and recover, as well. In this American Heart Association scientific statement, we (1) review age-related physiological changes that predispose to acute coronary syndrome and management complexity; (2) describe the influence of commonly encountered geriatric syndromes on cardiovascular disease outcomes; and (3) recommend age-appropriate and guideline-concordant revascularization and acute coronary syndrome management strategies, including transitions of care, the use of cardiac rehabilitation, palliative care services, and holistic approaches. The primacy of individualized risk assessment and patient-centered care decision-making is highlighted throughout.

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“…26 Symptoms of SIHD in older adults such as dyspnea and fatigue frequently overlap with symptoms attributable to noncardiac conditions common in older adults, such as chronic lung disease, malignancy, anemia, frailty, depression, and chronic kidney disease. 27 This has important implications for therapeutic expectations for patients and clinicians. Figure 2 Based on randomized trial evidence, we agree with current American and European guideline recommendations, which support an initial medical therapy approach with antianginal treatment in most patients with stable angina, including older adults, with revascularization primarily reserved for patients with unacceptable angina despite medical therapy.…”

Section: Clinical Phenotypesmentioning

confidence: 99%

“…26 Symptoms of SIHD in older adults such as dyspnea and fatigue frequently overlap with symptoms attributable to noncardiac conditions common in older adults, such as chronic lung disease, malignancy, anemia, frailty, depression, and chronic kidney disease. 27 This has important implications for therapeutic expectations for patients and clinicians. Figure 2 presents different clinical phenotypes potentially encountered in older adults with SIHD, with examples of common symptoms of stable angina seen in older adults and both cardiac and noncardiac clinical comorbidities that may influence both symptomatic burden and response to treatment.…”

Section: Overall Burden and Clinical Presentations Of Sihd In Older P...mentioning

confidence: 99%

Management of Stable Angina in the Older Adult Population

Nanna

Wang

Damluji

2023

Circ: Cardiovascular Interventions

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As society ages, the number of older adults with stable ischemic heart disease continues to rise. Older adults exhibit the greatest morbidity and mortality from stable angina. Furthermore, they suffer a higher burden of comorbidity and adverse events from treatment than younger patients. Given that older adults were excluded or underrepresented in most randomized controlled trials of stable ischemic heart disease, evidence for management is limited and hinges on subgroup analyses of trials and observational studies. This review aims to elucidate the current definitions of aging, assess the overall burden and clinical presentations of stable ischemic heart disease in older patients, weigh the available evidence for guideline-recommended treatment options including medical therapy and revascularization, and propose a framework for synthesizing complex treatment decisions in older adults with stable angina. Due to evolving goals of care in older patients, it is paramount to readdress the patient’s priorities and preferences when deciding on treatment. Ultimately, the management of stable angina in older adults will need to be informed by dedicated studies in representative populations emphasizing patient-centered end points and person-centered decision-making.

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Management and Care of Older Cardiac Patients

Cited by 10 publications

References 147 publications

Percutaneous Coronary Intervention in Older Patients With ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock

Percutaneous Coronary Intervention in Older Patients With ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock

Management of Acute Coronary Syndrome in the Older Adult Population: A Scientific Statement From the American Heart Association

Management of Stable Angina in the Older Adult Population

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