Acute Coronary Syndrome in the Older Adult Populations

Abstract

Coronary artery disease remains one of the major causes of mortality and morbidity in the older adult population. The aging process further increases the risk of adverse outcomes after acute coronary syndromes because coronary artery disease complexity is enhanced with advanced age by the presence of calcification, bifurcation lesions, and multivessel or left main involvement. Common geriatric syndromes like multimorbidity, polypharmacy, cognitive impairment, delirium, frailty, disability, and functional decline play a major role in the management and prognosis of acute coronary syndrome while simultaneously leading to worse geriatric impairment, including disability, during follow-up. Management of an acute coronary syndrome in older adults follows the same principles as of younger populations, but the utilization of guideline-recommended therapies is usually limited in older patients because of poor prognosis and increased risk of adverse events. Physicians should be aware of the available evidence regarding the safety and efficacy of pharmacological and interventional therapies in older patients for the best possible outcome. Rather than using a “one size fits all” approach, therapeutic interventions should be tailored at an individual level along with shared decision-making with the patient and their caregivers to achieve an overall improved quality of life as a precept to a holistic approach to cardiovascular care in older adults.