[Ischemic heart disease in the elderly. Special Conference of the 36th National Congress of the Spanish Society of Cardiology].
In the field of Cardiology, older patients are the most frequently seen in clinical practice. In the USA, 60% of the patients hospitalized with acute myocardial infarction are 65 or older, as are almost 80% of the patients with heart failure. Population in industrialized countries is aging progressively and this fact is particularly pronounced in Spain, where, as calculated, the population pyramid will be inverted in the next 50 years and people over 65 will be a majority group. We know that age is a determinant factor in the prognosis of illness. With age, comorbidity increases, sex distribution changes, mortal complications have a higher incidence, and there are structural and mechanical functional changes. The specific characteristics of this group of patients and their enormous impact in clinical practice have led us to reconsider the medical focus used to approach this very important aspect of public health. Many of the larger randomized clinical trials have included a narrow spectrum of older patients despite the great relevance that the study of this group might have. On the other hand, the extrapolation of the results obtained in younger patients to older patients implies that the average results of the study may be assigned to a heterogeneous population, not taking into consideration the specificities of each subgroup. Therefore, there is a need to create innovative strategies to optimize the results in the older patient group. Even though clinical trials are a very useful tool to establish the effectiveness of a therapy, from a methodological point of view, they should include a higher number of older patients, and the observational studies undertaken with a rigorous methodology should be more frequently used to generate new knowledge and put the established knowledge info practice. Furthermore, observational studies can be particularly important in the development of strategies that allow the translation of information from the clinical trials to daily clinical practice.
Krumholz
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D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000188:drug therapy / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic