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ISSN: 2167-7182

Journal of Gerontology & Geriatric Research
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Research Article

Elderly Patients with Non-ST-Elevation Acute Coronary Syndrome: A Proposal to Adapt Decision Making

Baldomero Alvarez-Fernandez1, M Rosa Bernal-Lopez 2,3*, Ribera Cabeo Inmaculada2, De Mora Martin Manuel4, Urbano Carrillo Cristobal5, Quesada Garcia Guillermo5, Arboleda Juan Andrés5, and Gomez-Huelgas Ricardo2,3
1Geriatric Unit- Internal Medicine Department, Regional University Hospital of Málaga (Carlos Haya Hospital), Spain
2Internal Medicine Department, Biomedical Institute of Málaga (IBIMA) Regional University Hospital of Málaga (Carlos Haya Hospital), Spain
3Ciber Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
4Cardiology Department, Biomedical Institute of Malaga (IBIMA), Regional University Hospital of Málaga (Carlos Haya Hospital), Spain
5Critical Care and Emergency Department, Regional University Hospital of Málaga (Carlos Haya Hospital), Spain
Corresponding Author : Dr. M Rosa Bernal-Lopez
Internal Medicine Department
Biomedical Research Institute of Malaga (IBIMA)
Regional University Hospital of Malaga (Carlos Haya Hospital), Avenida
Hospital Civil, s/n. 29009, Malaga, Spain
Tel: +34 951290346
Fax: +34 951290302
E-mail: [email protected]
Received June 09, 2015; Accepted July 15, 2015; Published July 18, 2015
Citation: Alvarez-Fernandez B, Bernal-Lopez MR, Cabeo Inmaculada R, Martin Manuel DM, Carrillo Cristobal U, et al. (2015) Elderly Patients with Non-STElevation Acute Coronary Syndrome: A Proposal to Adapt Decision Making. J Gerontol Geriat Res 4:227. doi:10.4172/2167-7182.1000227
Copyright: © 2015 Alvarez-Fernandez B, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

The guidelines recommend invasive treatment (coronary angiography) in elderly patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) with a moderate and high risk of re-infarction or death. The invasive approach has been found to be more effective in older and higher risk patients. The aim of this study was twofold: first, to determine whether the recommendations of current guidelines are followed for elderly patients with NSTE-ACS in our hospital; and second, to reach agreement among professionals responsible for the care of these patients (cardiologists, geriatricians, internists, specialists in emergency and critical care) on criteria that could enable the correct identification of the limitations of invasive management. Consistent with other studies and records in Spain and in neighbouring countries we found a tendency to deprive many patients of invasive treatment due solely to their age, with no underlying functional or cognitive factors or associated disorders that warranted it; hence the importance of developing multidisciplinary consensus criteria for the adequacy of invasive treatment in elderly patients with NSTE-ACS. The consensus criteria expressed in this manuscript could significantly aid decision-making in these patients and serve as a communication tool between the different specialists involved in their care. The usefulness of these criteria should be tested in future studies to assess whether their application helps to reduce the variability in clinical practice and improve clinical outcomes in the elderly population, especially in very elderly individuals.

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