Considerations in Cardiac Revascularization for the Elderly Patient: Age Isn't Everything

Coronary artery disease is the leading cause of morbidity and mortality even in the elderly population. Treatment opportunities in the elderly population are often underappreciated. Revascularization procedures (coronary artery bypass graft surgery and percutaneous coronary intervention) can be associated with important benefits in symptom control, quality of life, and long-term mortality, at an upfront cost of an increased risk of in-hospital mortality and morbidity. Risk models to assess periprocedural risk are useful. The best models would balance unique aspects of risk with the very real potential benefit of revascularization. Current models fall short in this regard. Frailty, a clinical syndrome of vulnerability, is present in 25%-50% of cardiac patients, and is associated with increased morbidity and mortality. The addition of frailty can improve the discrimination of risk models. Elderly patients commonly consider quality of life to have greater importance than mortality outcomes. Furthermore, hospital admission is associated with a reduction in mobilization, loss of muscle strength, and worsening frailty, and interferes with a fundamental value in the elderly: the maintenance of independence. Therefore, an understanding of frailty, quality of life, and other unique aspects of risk, as well as individual patient goals, can assist in further defining prognosis and refine decision-making in this important and vulnerable population.