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Review
. 2024 Jul 28;13(15):4416.
doi: 10.3390/jcm13154416.

Management of Acute Coronary Syndromes in Older People: Comprehensive Review and Multidisciplinary Practice-Based Recommendations

Ahthavan Narendren  1   2 , Natalie Whitehead  1 , Louise M Burrell  1   3 , Matias B Yudi  1 , Julian Yeoh  1 , Nicholas Jones  1   3 , Laurence Weinberg  4   5 , Lachlan F Miles  4   5 , Han S Lim  1   2   3 , David J Clark  1   3 , Ali Al-Fiadh  1   3 , Omar Farouque  1   3 , Anoop N Koshy  1   3   6
Affiliations
Review

Management of Acute Coronary Syndromes in Older People: Comprehensive Review and Multidisciplinary Practice-Based Recommendations

Ahthavan Narendren et al. J Clin Med. .

Abstract

Managing health care for older adults aged 75 years and older can pose unique challenges stemming from age-related physiological differences and comorbidities, along with elevated risk of delirium, frailty, disability, and polypharmacy. This review is aimed at providing a comprehensive analysis of the management of acute coronary syndromes (ACS) in older patients, a demographic substantially underrepresented in major clinical trials. Because older patients often exhibit atypical ACS symptoms, a nuanced diagnostic and risk stratification approach is necessary. We aim to address diagnostic challenges for older populations and highlight the diminished sensitivity of traditional symptoms with age, and the importance of biomarkers and imaging techniques tailored for older patients. Additionally, we review the efficacy and safety of pharmacological agents for ACS management in older people, emphasizing the need for a personalized and shared decision-making approach to treatment. This review also explores revascularization strategies, considering the implications of invasive procedures in older people, and weighing the potential benefits against the heightened procedural risks, particularly with surgical revascularization techniques. We explore the perioperative management of older patients experiencing myocardial infarction in the setting of noncardiac surgeries, including preoperative risk stratification and postoperative care considerations. Furthermore, we highlight the critical role of a multidisciplinary approach involving cardiologists, geriatricians, general and internal medicine physicians, primary care physicians, and allied health, to ensure a holistic care pathway in this patient cohort.

Keywords: acute coronary syndrome; cardiovascular disease; coronary artery disease; frailty; multimorbidity; octogenarians; older adults.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Age-related changes predisposing older adults to acute coronary syndromes.
Figure 2
Figure 2
Evaluation of acute coronary syndrome in older adults.
Figure 3
Figure 3
Proposed risk stratification guide for antiplatelet strategies in older patients post-acute coronary syndrome. ARC-HBR: Academic Research Consortium for High Bleeding Risk; DAPT: dual antiplatelet therapy; mths: months; SAPT: single antiplatelet platelet therapy.
Figure 4
Figure 4
Geriatric syndromes and key management strategies.
See this image and copyright information in PMC

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