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Contextualizing Myocardial Infarction: Comorbidities and Priorities in Older Adults

Ashok Krishnaswami1, Mathew S Maurer2, Karen P Alexander3

  • 1Division of Cardiology, Kaiser Permanente San Jose Medical Center, San Jose, Calif; Department of Epidemiology and Biostatistics, University of California, San Francisco, Calif.

The American Journal of Medicine
|July 9, 2017
PubMed

Insights

Caring for older adults with multiple health issues requires a shift from evidence-based to value-based geriatric care. This approach optimizes treatment for complex cardiovascular conditions in the elderly.

Area of Science:

  • Geriatric Cardiology
  • Internal Medicine
  • Cardiovascular Biomarkers

Background:

  • Cardiovascular care for aging populations is complicated by increasing comorbidity.
  • Geriatric patients frequently present with multiple chronic conditions requiring acute cardiac care.
  • Abnormal cardiac biomarkers in patients with noncardiac conditions are common admission reasons for older adults.

Observation:

  • Type 2 myocardial infarction (MI) in older adults with multiple comorbidities presents diagnostic and therapeutic challenges.
  • Standard guideline-based care may not be optimal for elderly patients with complex health profiles.
  • A case study illustrates the complexities of managing type 2 MI in an older adult.

Findings:

  • Type 2 MI, often triggered by noncardiac conditions, necessitates careful evaluation in older patients.
  • Managing acute coronary syndromes in the elderly requires a nuanced approach beyond single-disease protocols.
  • The case highlights the need for individualized treatment strategies in geriatric cardiovascular care.

Implications:

  • A value-based geriatric mindset is crucial for optimizing cardiovascular care in older adults.
  • Shifting focus from purely evidence-based to value-based care can improve outcomes for complex geriatric patients.
  • This approach supports better decision-making for internists, hospitalists, and cardiologists managing elderly patients.

Keywords:
Cardiovascular careOlder adultsValue-based geriatric care

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