senior lifestyle
Managing Heart-Attack
Treatment and
Follow-Up Care for
Older Adults
Family Features
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A s the proportion of older adults
in the United States continues
to increase, appropriate care
for older people becomes increasingly
important. In fact, caregivers and loved
ones should be aware of age-appropri-
ate care for heart attack or chest pain.

The fi rst step is to call 911. Once
medical care is started, age-related
changes in general health and in the
heart and blood vessels require consid-
eration, and likely modifi cations, in how
people age 75 and older are treated,
according to a scientifi c statement
from the American Heart Association,
published in its fl agship, peer-reviewed
journal “Circulation.”
The statement, “Management of acute
coronary syndrome in the older adult
population,” highlights evidence to help
clinicians better care for older patients.

According to the statement, 30% to
40% of people hospitalized with ACS,
which includes heart attack and unsta-
ble angina (heart-related chest pain), are
75 or older.

“Older 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,” said Dr. Abdulla A. Damluji,
chair of the scientifi c statement writing
committee, director of the Inova Center
of Outcomes Research and an associate
professor of medicine at Johns Hopkins
School of Medicine. “These include
frailty, other chronic disorders (treated
with multiple medications), physical
dysfunction, cognitive decline or urinary
incontinence.” Age-Related Changes in Heart
and Blood Vessels
Cardiovascular changes that occur with
normal aging make ACS more likely and
may make diagnosing and treating it
more complex. These changes include
large arteries becoming stiff er, the heart
working harder but pumping less eff ec-
tively, blood vessels becoming less fl exi-
ble and less able to respond to changes
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in the heart’s oxygen needs and an
increased tendency to form blood clots.

Sensory decline due to aging may
alter hearing, vision and pain sensations.

Kidney function also declines with age,
with more than one-third of people 65
and older having chronic kidney disease.

As people age, they are often
diagnosed with health conditions that
may be worsened by ACS or complicate
existing ACS. As these chronic condi-
tions are treated, medications prescribed
may result in unwanted interactions or
medications that treat one condition but
may worsen another.

“Geriatric syndromes and the complex-
ities of their care may undermine the
eff ectiveness of treatments for ACS, as
well as the resiliency of older adults
to survive and recover,” Damluji said.

“A detailed review of all medications,
including supplements and over-the-
counter medicines, is essential, ideally in
consultation with a pharmacist who has
geriatric expertise.”
Steps for Heart-Attack Care
and Follow-Up
• Call 911 if you notice someone expe-
riencing heart-attack warning signs.

These include chest discomfort, dis-
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comfort in other areas of the upper
body (one or both arms, back, neck,
jaw or stomach), shortness of breath
or other symptoms such as a cold
sweat, nausea or lightheadedness.

• Consider treatment needs for co-ex-
isting conditions. An individualized,
patient-centered approach is best for
older adults.

• Get input from multiple specialists,
including a pharmacist, to manage
care and medications.

• People with cognitive diffi culties and
limited mobility may benefi t from a
simplifi ed medication schedule, with
fewer doses per day and 90-day sup-
plies of medications so fewer refi lls
are necessary.

• The goals of care for older people with
ACS should extend beyond clinical
outcomes and focus on quality of life
and the ability to live independently.

• Do-not-resuscitate orders should be
discussed before any surgery or pro-
cedure. ■
For more information about managing
ACS in older adults, visit Heart.org.

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