Consensus of the French Society of Gerontology and Geriatrics and the French Society of Cardiology for the management of coronary artery disease in older adults.
Coronary heart disease is a common and serious condition in patients aged over 80 years. The presenting clinical symptoms are all the more atypical and the prognosis poorer when it occurs in patients with multiple comorbid diseases. The presence of comorbidities dictates the need for a standardized geriatric assessment to screen for the existence of underlying frailty. The available scientific data were obtained during studies that included few subjects aged over 80 years. These recommendations are therefore mainly extrapolated from results obtained in younger populations. The pharmacological management and revascularization strategy for coronary heart disease in octogenarians is basically the same as in younger subjects. Epidemiological studies all concur that available therapies are underutilized despite the fact that this population has a high cardiovascular risk. Specific precautions for use must be respected because of the comorbidities and age-related changes in pharmacokinetics or pharmacodynamics. Generally, the therapeutic strategy in coronary heart disease is based not on the patient's real age, but rather on an individual analysis taking into account the severity of the coronary disease, comorbidities, the risk of drug misadventures, patient life expectancy and quality of life.
Hanon
Olivier
O
Department of Geriatrics, université Paris-Descartes, hôpital Broca, 54-56, rue Pascal, 75013 Paris, France. olivier.hanon@brc.ap-hop-paris.fr
Baixas
Cécile
C
Friocourt
Patrick
P
Carrié
Didier
D
Emeriau
Jean-Paul
JP
Galinier
Michel
M
Belmin
Joel
J
de Groote
Pascal
P
Bénétos
Athanase
A
Jourdain
Patrick
P
Berrut
Gilles
G
Aupetit
Jean-François
JF
Jondeau
Guillaume
G
Danchin
Nicolas
N
Forette
Françoise
F
Komajda
Michel
M
D000367:Age Factors; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D019317:Evidence-Based Medicine; D005260:Female; D015577:Geriatric Assessment; D006299:Health Services for the Aged / Q000592:standards*; D006334:Heart Function Tests / Q000592:standards*; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000592:standards*; D018579:Patient Selection; D011237:Predictive Value of Tests; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D002317:Cardiovascular Agents