Hearts and bodies change with age, and treatment for heart disease may need to change as well

Hearts and bodies change with age, and treatment for heart disease may need to change as well

We highlight the statement:

  • A new scientific statement from the American Heart Association provides updated information on how aging affects the diagnosis and treatment of heart attacks in people age 75 and older.

  • Changes in the cardiovascular system associated with normal aging and non-cardiac medical conditions that become more common with age should be considered in heart attack treatment planning and follow-up.

  • Appropriate care for the elderly is increasingly important as the proportion of elderly people in the population continues to grow.

Embargoed until 4 am.m. CT / 5 a.m. ET Monday, December 12, 2022

(NewMediaWire) – December 12, 2022 – DALLAS For people age 75 and older, age-related changes in general health and the heart and blood vessels warrant consideration and likely changes in the way heart attacks and heart disease are treated, according to a new American Heart Scientific statement of the Association published today in the Association’s leading peer-reviewed magazine Circulation.

The new statement, “Treatment of acute coronary syndrome (ACS) in the older adult population,” highlights recent evidence to help clinicians better care for patients older than 75 years. According to the statement, 30-40% of people hospitalized with ACS are age 75 or older. ACS includes heart attack and unstable angina (heart-related chest pain).

A statement is an update of a 2007 American Heart Association Statement on the treatment of heart attacks in the elderly.

Clinical practice guidelines are based on clinical trial research. “However, older adults are often excluded from clinical trials because their health needs are more complex compared to younger patients,” said Abdulla A. Damluji, M.D., Ph.D., FAHA, Scientific Statement Writing Committee Chair, Director of of the Inova Center for Outcomes Research in Fairfax, Virginia, and an associate professor of medicine at the Johns Hopkins School of Medicine in Baltimore.

“Older patients have more pronounced anatomical changes and more severe functional impairments, and are more likely to have additional health conditions unrelated to heart disease,” Damluji said. “These include frailty, other chronic disorders (treated with multiple medications), physical dysfunction, cognitive decline, and/or urinary incontinence, and these are not routinely studied in the context of ACS.”

Normal aging and age-related changes in the heart and blood vessels

Cardiovascular changes that occur with normal aging make ACS more likely and can make diagnosis and treatment more complex: large arteries become stiffer; the heart muscle often works harder but pumps less efficiently; blood vessels are less flexible and less able to respond to changes in the heart’s needs for oxygen; and there is an increased tendency to form blood clots. Sensory decline due to aging can also change hearing, vision and pain sensations. Kidney function also declines with age, with more than one-third of people age 65 and older having chronic kidney disease. These changes should be taken into account when diagnosing and treating ACS in the elderly.

These considerations include:

  • ACS is more likely to occur without chest pain in older adults, presenting with symptoms such as shortness of breath, fainting, or sudden confusion.

  • Measuring troponin enzyme levels in the blood is the standard test for diagnosing heart attacks in younger people. However, troponin levels may already be higher in older people, especially those with kidney disease and stiff heart muscle. Assessment of the rise and fall patterns of troponin levels may be more appropriate when used to diagnose heart attacks in older adults.

  • Age-related changes in metabolism, weight, and muscle mass may require different choices of anticoagulants to reduce the risk of bleeding.

  • As kidney function declines, the risk of kidney injury increases, especially when contrast agents are used in imaging tests and imaging-guided procedures.

  • Although many clinicians avoid cardiac rehabilitation for frail patients, they often benefit the most.

  • Ensuring that medications and other therapies continue when people move from a hospital to an outpatient care center is especially important for older adults who are vulnerable to frailty, decline, and complications during these transitions.

Various medical conditions and medications

As people age, they are often diagnosed with health problems that may be exacerbated by ACS or may complicate existing ACS. While these chronic conditions are being treated, the number of medications prescribed can result in unwanted interactions, or medications that treat one condition can make another condition worse.

“Geriatric syndromes and the complexity of their care can undermine the effectiveness of ACS treatment, as well as the resilience of older adults to survive and recover,” Damluji said. “A thorough review of all medications, including dietary supplements and over-the-counter medications, ideally in consultation with a pharmacist with geriatric experience, is key.”

An individualized, patient-centered approach to ACS care, taking into account coexisting conditions and the need for multidisciplinary input, is best for older adults. Ideally, multidisciplinary teams caring for older adults with ACS include cardiologists, surgeons, geriatricians, primary care clinicians, nutritionists, pharmacists, cardiac rehabilitation specialists, social workers, nurses, and family members.

In addition, people with cognitive impairments and limited mobility can benefit from a simplified medication schedule, with fewer doses per day and a 90-day supply of medication, so fewer refills are needed. Monitoring symptom burden, functional status, and quality of life during postdischarge follow-up is important to provide insight into how the patient is progressing toward their goals of care and to measure potential for improvement.

Patient preferences and life expectancy

Older adults vary widely in their independence, physical or cognitive limitations, life expectancy, and goals for the future. The goals of care for older adults with ACS should go beyond clinical outcomes (such as bleeding, stroke, second heart attack, or the need for repeat procedures to reopen arteries). Goals focused on quality of life, ability to live independently, and/or return to a previous lifestyle or living environment are important to consider when planning care for older adults with ACS. Additionally, Do Not Resuscitate (DNR) orders should be discussed prior to any surgery or procedure.

  • Although the risks are higher, bypass surgery or procedures to reopen the blocked artery are beneficial for selected older adults with ACS.

  • If invasive treatment is chosen, the DNR order may need to be suspended for the duration of the procedure.

  • If invasive treatment is not chosen, palliative care can help manage symptoms, improve quality of life and provide psychosocial support.

  • Important benchmarks for quality care include measurable goals, such as days spent at home and relief of pain and discomfort.

This scientific statement was prepared by a volunteer writing group on behalf of the American Heart Association’s Committee on Cardiovascular Disease in Older Populations of the Council on Clinical Cardiology; Cardiovascular Disease and Stroke Care Council; Council for Cardiovascular Radiology and Intervention; and the Council on Lifestyle and Cardiometabolic Health. Scientific statements from the American Heart Association promote greater awareness of cardiovascular disease and stroke issues and help make informed health care decisions. Scientific statements describe what is currently known about a topic and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations. The American Heart Association guidelines provide the Association’s official recommendations for clinical practice.

Co-authors are Vice President Daniel E. Forman, MD, FAHA; Tracy Y. Wang, MD, MHS, M.Sc., FAHA; Joanna Chikwe, MD, FAHA; Vijay Kunadian, MBBS, MD; Michael W. Rich, MD; Bessie A. Young, MD, MPH; Robert L. Page II, Pharm.D., MSPH, FAHA; Holli A. DeVon, Ph.D., RN, FAHA; and Karen P. Alexander, MD, FAHA. Author publications are listed in the manuscript.

The association receives funds primarily from individuals. Foundations and corporations (including pharmaceutical companies, device manufacturers and other companies) also make donations and fund special programs and events of the Association. The association has strict policies to prevent these relationships from influencing the scientific content. Income from pharmaceutical and biotechnology companies, device manufacturers and health insurance providers, as well as the total financial data of the Association, are available. here.

Additional resources:

About the American Heart Association

The American Heart Association is an unrelenting force for a world of longer, healthier lives. We are committed to ensuring equal health in all communities. Through collaboration with numerous organizations and with the support of millions of volunteers, we fund innovative research, advocate for public health and share resources that save lives. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us at srce.org, Facebook, Twitter or by calling 1-800-AHA-USA1.

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For media inquiries: 214-706-1173

Maggie Francis: 214-706-1382; [email protected]

For public inquiries: 1-800-AHA-USA1 (242-8721)

srce.org and stroke.org



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