Optimised care of elderly patients with acute coronary syndrome

Advancing life expectancy is being paralleled by a continuous increase of elderly patients with several acute cardiovascular conditions, including acute coronary syndrome (ACS). Paradoxically, despite the rising prevalence of elderly patients, older age has been a typical exclusion criterion of randomised controlled trials assessing the efficacy and safety of therapies in these patients. Therefore, the evidence to inform optimal care delivery to elderly patients with ACS is limited. Challenges in the clinical management of older patients with ACS include accurate clinical assessment, optimal selection of revascularisation and antithrombotic strategies, and decisions on the appropriate level of care once the expected patient prognosis and quality of life has been determined. In this review we provide an overview of these challenges, including practical suggestions for their management. Unless otherwise specified, by ‘elderly’ we mean individuals 75 years of age or older.

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