Issues with care in the elderly patient presenting with acute ischemia

The issues surrounding care of the elderly patient with acute coronary syndromes (ACS) present significant challenges to clinicians and investigators. The elderly often have atypical symptoms of acute ischemia, have greater medical comorbidities, and are more likely to die from ischemic heart disease. Important differences exist among elderly patients with ACS as compared with their younger counterparts, including age-related changes in physiology, metabolism of drugs, and overall functional status, all of which influence treatment patterns and clinical outcomes. Given the absence of elderly patients in many clinical trials, these high-risk individuals are sometimes managed with more conservative strategies, which at times diverge from accepted guidelines. This review addresses clinically important issues in the care of elderly patients with acute ischemia and highlights recent studies that provide new insight into this complex area of cardiovascular care.