Abstract
Acute coronary syndrome (ACS) is one of the main causes of mortality and morbidity in the elderly. The prevalence of ACS increases with age and patients with advanced age have some co-morbidities that require an individualized approach, which includes a comprehensive geriatric assessment. Ageism is a matter of great concern. In this scenario, some ethical conflicts may arise which should be anticipated, considered, and solved. Clinicians will need to prioritize and allocate resources, to avoid futility/proportionality, which is not always easy to assess in these patients. This review aims to summarize the evidence regarding ethical conflicts that may arise in the management of patients with ACS and advanced age. We will discuss how to choose the best option (which frequently is not the only one) with the lowest risk for harm, considering and respecting the patients' decision. The four basic principles of bioethics (beneficence, non-maleficence, autonomy, and justice) are thoroughly reviewed, and discussed, regarding their role in the decision making process.
Highlights
Acute coronary syndrome (ACS) is one of the main causes of mortality and morbidity in the elderly
This review aims to summarize the published evidence regarding ethical conflicts that may arise in the management of elderly patients with ACS and how they can be managed according to different bioethical principles [5–7]
The incidence of ACS will progressively increase with aging of the population, and will produce an increase in the number of elderly patients admitted with ACS
Summary
Acute coronary syndrome (ACS) is one of the main causes of mortality and morbidity in the elderly. Patients with advanced age have co-morbidities [3,4] that make individualized management essential In this complex scenario, some ethical conflicts may arise which should be anticipated, considered, and solved. Decisions in elderly patients with ACS, as in their younger counterparts, should be based on the basic principles of bioethics (beneficence, non-maleficence, autonomy, and justice) [5]. This implies that clinicians should choose the best option for each patient to avoid harm, and to consider and respect his/her decision using the proper allocation of resources. Topics such as ageism, prioritization, and futility will be reviewed
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