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Challenges and Controversies in the Management of ACS in Elderly Patients

Waleed T Kayani1, Mahin R Khan2, Matthew R Deshotels3

  • 1Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA. kayani@bcm.edu.

Current Cardiology Reports
|June 6, 2020
PubMed

Insights

Elderly patients with acute coronary syndrome (ACS) often lack typical symptoms and require careful diagnosis. Evidence shows an early invasive strategy is beneficial, but undertreatment persists, highlighting disparities in care.

Area of Science:

  • Cardiology
  • Geriatric Medicine
  • Internal Medicine

Background:

  • Elderly patients with acute coronary syndrome (ACS) present diagnostic challenges due to atypical symptoms.
  • Pathophysiology involves disrupted coronary plaques, with elderly patients showing more calcified nodules.

Purpose of the Study:

  • To review the challenges and optimal management strategies for ACS in elderly patients.
  • To highlight the need for high suspicion in diagnosing ACS in this demographic.

Main Methods:

  • Review of current literature on ACS management in the elderly.
  • Analysis of diagnostic and therapeutic approaches, including invasive strategies and pharmacotherapy.

Main Results:

  • Elderly patients are less likely to exhibit typical anginal symptoms.
  • An early invasive strategy is generally superior for non-ST-elevation ACS (NSTE-ACS) in the elderly.
  • Careful medication adjustment is crucial, considering comorbidities and bleeding risk.

Conclusions:

  • Elderly ACS patients are often undertreated with evidence-based therapies.
  • They experience worse outcomes, indicating healthcare disparities.
  • Optimizing care for this population is essential to mitigate disparities.
Abstract

Keywords:
Acute coronary syndromeAntiplatelet therapyElderlyOctogenariansOlder adults

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