TY  - JOUR
AU  - Cocco, Giuseppe
AU  - Amiet, Philipp
PY  - 2020
DA  - 2020/03/19
TI  - Known–Unknowns in Geriatric Cardiology
JO  - OBM Geriatrics
SP  - 111
VL  - 04
IS  - 01
AB  - The present article summarizes the current state of understanding in geriatric cardiology in terms of the main developments in the field. The focus of the present review is on the therapeutics, into the specific characteristics of the elderly pa­tients dealing with the prevention of arterial hypertension, bradycardic arrhythmias, atrial fibrillation, coronary artery syndromes, valve heart diseases, and heart failure. Progress in the field of medicine has rendered it possible to treat lethal cardiac diseases in the extremely old pa­tients. Nonetheless, data regarding the very old cardiac patients are limited, and it is dangerous to directly extrapolate the experi­ence with the young patients to the old ones. ● Preventive therapies are important in the old cardiac patients, although these therapies differ from those for young patients. ● Very old patients with arterial hypertension benefit from antihypertensive treatment, although the therapeutic strategy of one-size-fits-all cannot be applied. ● Elderly patients often require a cardiac pacemaker. In the case of patients with sinus node dysfunction, pacing modes capable of preserving atrioventricular syn­chrony are associated with a reduced incidence of atrial fibrillation. In the case of patients with atrioventricular block, the importance of synchronization is debatable. Implantable cardioverter-defibrillators may be used in very old patients, although a limited number of studies evidencing this in elderly patients are available. ● In very old patients with atrial fibrilla­tion, ablative therapies are seldom used. OAC is useful in such cases, although the HAS-BLED score is inadequate for as­sessing the real bleeding risk in the old people. ● Patients who are ≥80 years old and exhibit acute coronary syndromes would benefit more from a myocardial revascularization compared to a medical therapy, while in the patients who are ≥90 years old, revascularization and medical therapy are equivalent. ● In the very old patients with severe aortic stenosis, transcatheter valve replacement is safe and efficient, while antithrombotic therapy is problematic. The treatment of mitral regurgitation is different in the very old and the young patients; the mortality is high and there is no consensus on the best therapy. Tricuspid regurgitation is recognized as a serious problem in certain old cardiac patients; however, the best therapeutic approach to this problem has not been discovered so far. ● Information regarding the geriatric patients with heart failure is inadequate due to lack of clinical details in the population-based studies and because clinical trials typically enroll younger patients. Elderly patients with heart failure constitute a heterogeneous group and differ substantially from the younger patients enrolled in the clinical trials. The limited data indicate that a proven therapy for heart failure that reduces mortality and morbidity in the younger pa­tients is also beneficial in elderly patients. However, elderly patients exhibit different responses to the pharmacotherapy in comparison to the younger patients, as the former are susceptible to adverse events, such as orthostatic hypoten­sion, renal dysfunction, electrolyte disturbances, and interactions with the medications prescribed for the treatment of comorbidities. Close monitoring of elderly patients undergoing HeFa treatment is essential to ensure optimal outcomes. The number of old people is large, and progress in the field of medicine has made it possible to treat lethal cardiac diseases in very old patients. Certain individuals are biologically younger in comparison to their anagraphic age; however, geriatric patients are often frail and exhibit much comorbidities. The demand for invasive therapies and novel drugs has led to rapidly increasing expendi­tures. Practicing cardiologists are encountering in­creasing number of consultations for very old patients. This creates a requirement for training a greater number of geriatric cardi­ologists to offer the best of care to the old patients. Owing to the comorbidities, several of which are critical in nature, in the elderly patients, the geriatric cardiologists must be, first of all, master internists at all times. Old patients, with their peculiar pharmacokinetics and multiple illnesses, are also oversensitive to drugs. Several aspects of geriatric cardiology are unknown even now. There is a necessity to understand the effects exerted by the aging process on the human heart. Studies in this direction should command priority in the financial as well as the other forms of support.
SN  - 2638-1311
UR  - https://doi.org/10.21926/obm.geriatr.2001111
DO  - 10.21926/obm.geriatr.2001111
ID  - Cocco2020
ER  -