Treatment plans for heart attacks and heart-related chest pain may require modification for people 75 and older due to age-related changes in the heart and blood vessels, as well as overall health, according to a new report from the American Heart Association.
The new report is an updated version of the 2007 statement. It highlights recent evidence to assist medical professionals in caring for older adults.
According to the new report, 30-40% of people hospitalized for heart attacks and heart-related chest pain are 75 and older. However, the researchers noted that people in this age group are frequently excluded from clinical practice guidelines research because it is widely assumed that their health care needs are more complex than those of younger patients.
“Older patients have more pronounced anatomical changes and more severe functional impairment, and they are more likely to have additional health conditions,” said Dr. Abdulla A. Damluji, director of the Inova Center of Outcomes Research in Fairfax, Virginia, and an associate professor of medicine at the Johns Hopkins School of Medicine in Baltimore.
Furthermore, the report stated that cardiovascular changes associated with aging increase the risk of a heart attack and make diagnosing and treating it more difficult.
The researchers also recommended that health providers consider other changes associated with aging, like poor kidney function, when treating and diagnosing heart attacks in older adults.
The report suggested a change in the method used to determine whether a person has a heart attack. For example, elevated troponin levels are typically used to signal that a heart attack has occurred. However, in older adults with kidney disease and stiffened heart muscles, there may already be higher enzyme levels.
Furthermore, the researchers noted that symptoms of heart-related chest pain could differ in older adults. For example, older adults may feel shortness of breath, pass out, or become suddenly confused instead of having chest pain.
The report emphasizes the importance of not foregoing treatments that could benefit older patients, such as cardiac rehabilitation, as it could help recover functionality following a heart attack. The statement also noted that healthcare professionals sometimes avoid sending older heart patients to rehab because they are frail. Still, research shows these patients benefit most from such services.
The report also stated there might be a need to change how medications are prescribed and managed. One of the reasons noted is polypharmacy. According to the researchers, older adults take multiple medications. Hence, it is important to look out for harmful drug interactions.
In addition, there is a need to keep a steady supply of patient medications on hand. According to the statement, simplified medication plans with fewer doses per day and 90-day supplies to avoid the need for frequent refills may be beneficial for people with cognitive difficulties and limited mobility.
“Geriatric syndromes and the complexities of their care may undermine the effectiveness of treatments for ACS, as well as the resiliency of older adults” in their recovery, Damluji said. “A detailed review of all medications – including supplements and over-the-counter medicines – is essential, ideally in consultation with a pharmacist who has geriatric expertise.”
Furthermore, the statement suggests personalized patient treatment plans for older adults with heart-related chest pain, with input from a multidisciplinary team that may include cardiologists, surgeons, geriatricians, primary care doctors, dietitians, social workers, and family members.
Finally, the committee stressed the significance of monitoring patients’ function and quality of life after hospitalization.
Source: American Heart Association