Acute coronary syndrome (ACS) is a group of conditions in which blood flow to the heart is reduced, including angina and heart attacks, or myocardial infarctions. According to the AHA, “ACS is more likely to occur without chest pain in older adults, presenting with symptoms such as shortness of breath, fainting or sudden confusion.”
“Management of Acute Coronary Syndrome (ACS) in the Older Adult Population,” highlights normal aging and age-related changes in the heart and blood vessels, and acknowledges that older adults often have multiple medical conditions and medications complicating diagnosis and treatment.
For example, large arteries and the heart muscle become stiffer with age, and the heart may work harder but pump blood less efficiently. Many normal changes increase the risk of blood clots.
“Age-related changes in metabolism, weight and muscle mass may necessitate different choices in anti-clotting medications to lower bleeding risk,” according to a press release. Kidney function also declines with age.
One of the issues the authors highlight is that clinical practice guidelines are based on clinical trial research, but older adults are often not included in trials because their health care needs are more complex when compared to younger patients.
According to said Abdulla A. Damluji, chair of the scientific statement writing committee and an associate professor of medicine at Johns Hopkins School of Medicine in Baltimore, “[o]lder patients have more pronounced anatomical changes and more severe functional impairment, and they are more likely to have additional health conditions not related to heart disease." “These include frailty, other chronic disorders (treated with multiple medications), physical dysfunction, cognitive decline and/or urinary incontinence – and these are not regularly studied in the context of ACS.”
The authors emphasize the need to look beyond the clinical outcomes for older adults, like bleeding, stroke, and heart attack, and to also focus on quality of life and the ability to live independently and/or return to their previous lifestyle or living environment.
