AHA updates guidelines for diagnosing, treating heart attacks in older adults

The American Heart Association released a new scientific statement Dec. 12 that updates information for diagnosing and treating acute coronary syndrome in people 75 and older.

Changes in the cardiovascular system associated with normal aging and non-heart-related medical conditions become more common with age and should be considered when planning heart attack treatment and follow-up, according to an article posted on the AHA website. 

The statement updates clinical practice guidelines, which were based on clinical trial research. "However, older adults are often excluded from clinical trials because their healthcare needs are more complex when compared to younger patients," Dr. Abdulla Damluji, PhD, a physician and director of the Inova Center of Outcomes Research in Fairfax, Va., said in the article.

"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," Dr. Damluji said. "These include frailty, other chronic disorders (treated with multiple medications), physical dysfunction, cognitive decline and/or urinary incontinence — and these are not regularly studied in the context of acute coronary syndrome."

Here are six updates:

1. Acute coronary syndrome is more likely to occur without chest pain in older adults, presenting with symptoms such as shortness of breath, fainting or sudden confusion.
   
   
2. Evaluating patterns of rise and fall in the enzyme troponin is more appropriate for diagnosing heart attacks in older adults because their troponin levels may already be higher.
   
   
3. Age-related changes in metabolism, weight and muscle mass may necessitate different choices in anti-clotting medications to lower bleeding risk.
   
   
4. As kidney function declines, the risk of kidney injury increases, particularly when contrast agents are used in imaging tests and procedures guided by imaging.
   
   
5. Elderly, frail patients often benefit the most from cardiac rehabilitation.
   
   
6. Ensuring medications and other therapies are continued when people are transferred from the hospital to an outpatient care center is particularly important in older adults who are vulnerable to frailty, decline and complications during these transitions.