Managing heart attack treatment and follow-up care

As the proportion of older adults in the U.S. continues to increase, appropriate care for older people becomes increasingly important. In fact, caregivers and loved ones should be aware of age-appropriate care for heart attack or chest pain.

The first step is to call 911. Once medical care is started, age-related changes in general health and in the heart and blood vessels require consideration, and likely modifications, in how people age 75 and older are treated, according to a scientific statement from the American Heart Association, published in its flagship, peer-reviewed journal “Circulation.”

The statement, “Management of acute coronary syndrome (ACS) in the older adult population,” highlights evidence to help clinicians better care for older patients. According to the statement, 30-40% of people hospitalized with ACS, which includes heart attack and unstable angina (heart-related chest pain), are age 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 Abdulla A. Damluji, M.D., Ph.D., FAHA, chair of the scientific 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.”

Normal Aging and Age-Related Changes in the 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 stiffer, the heart working harder but pumping less effectively, blood vessels becoming less flexible and less able to respond to changes 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 1/3 of people ages 65 and older having chronic kidney disease.

Multiple Medical Conditions and Medications

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

“Geriatric syndromes and the complexities of their care may undermine the effectiveness 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 for Older Adults

* Call 911 if you notice someone experiencing heart attack warning signs. These include chest discomfort, discomfort 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-existing 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 difficulties and limited mobility may benefit from a simplified medication schedule, with fewer doses per day and 90-day supplies of medications so fewer refills 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 procedure.
For more information about managing ACS in older adults, visit Heart.org.

(Family Features & American Heart Association, photo courtesy of Getty Images.)