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Common cardiovascular issues encountered in geriatric critical care
1Section of Cardiology, P3-Cards Department of Veterans Affairs Medical Center, 3710 Southwest US Veterans Hospital Road, Portland, OR 97207, USA. crispell@ohsu.edu
Insights
Cardiovascular disease (CV disease) is prevalent in older adults, especially in critical care. Treatment decisions for elderly patients require individualized risk-benefit analysis, not solely based on age.
Area of Science:
- Geriatrics
- Cardiology
- Critical Care Medicine
Background:
- Cardiovascular disease (CV disease) significantly impacts the growing US elderly population.
- CV disease is frequently a primary or secondary diagnosis in elderly patients requiring critical care.
- Therapeutic strategies for CV issues in critical care range from conservative medical management to advanced invasive procedures.
Purpose of the Study:
- To review therapeutic options for cardiovascular disease in elderly critical care patients.
- To emphasize individualized treatment approaches considering patient-specific factors.
- To highlight special considerations for end-of-life care, cardiac surgery, and ICD management in this demographic.
Main Methods:
- Review of current therapeutic modalities for cardiovascular disease in critical care.
- Analysis of factors influencing treatment decisions in elderly patients.
- Discussion of ethical and practical considerations in advanced cardiovascular care for seniors.
Main Results:
- Age is not an absolute contraindication for invasive cardiovascular therapies.
- Individualized risk-benefit assessments, including physiologic age and quality of life, are crucial.
- Therapeutic goals must be clearly defined for each elderly patient.
Conclusions:
- Treatment decisions for elderly critical care patients with CV disease necessitate a comprehensive, patient-centered approach.
- Invasive therapies can be considered based on careful risk-benefit analysis.
- Special attention to end-of-life care, cardiovascular surgery, and ICD deactivation is vital for this population.
Abstract:
The incidence and prevalence of CV disease is high in the growing US elderly population. It is common for CV disease to be either the primary or secondary problem for elderly patients receiving critical care. The therapeutic options for CV problems experienced in the critical care setting range from medical management with the goal of symptom relief and comfort care to invasive therapies such as PCI, intraaortic balloon pump therapy, invasive monitoring, and cardiac surgery. Age alone is not a contraindication for any of the invasive therapies. Instead, a careful risk-benefit analysis should be performed for each individual patient, taking into consideration physiologic age, comorbid conditions, other disabilities, and an assessment of quality of life. Additionally, the goals (symptom relief, improvement of quality of life, survival benefit) of any therapy should be clearly established for individual patients. End-of-life issues, cardiovascular surgery, and the disabling of ICDs deserve special consideration in the elderly, as these are often challenging issues that will likely be more frequently encountered in critical care settings as science and technology advance.