Atrial fibrillation(AF)is the most common arrhythmia in elderly population,with age being one of the most important factors involved in its pathogenesis.Conduction disturbances may be present on the surface electrocar...Atrial fibrillation(AF)is the most common arrhythmia in elderly population,with age being one of the most important factors involved in its pathogenesis.Conduction disturbances may be present on the surface electrocardiogram before AF onset in some patients.Once this arrhythmia is diagnosed,antithrombotic therapy is mandatory in most cases,as this is the only treatment that has demonstrated to improve survival.Age increases both the risk of thromboembolic and bleeding complications,while benefits from anticoagulant therapy outweigh that from bleeding in most scenarios,also in very elderly patients.However,elderly patients with AF are often undertreated.Non-vitamin K antagonist oral anticoagulants have emerged as an alternative to vitamin K antagonists,with significant less adverse events and better profile in terms of efficacy and safety.Other conditions related to age should be carefully evaluated in these patients(including frailty,comorbidity and polypharmacy)to ensure an individualized clinical and therapeutic approach.展开更多
1 Introduction Societies are ageing at an accelerated pace.This scenario is a well-known challenge for health care systems,as chronic diseases,multiple comorbidities and dependency are all entities that often converge...1 Introduction Societies are ageing at an accelerated pace.This scenario is a well-known challenge for health care systems,as chronic diseases,multiple comorbidities and dependency are all entities that often converge in the elderly.Besides,there is an issue regarding a reduction in the general incidence of acute coronary syndrome(ACS)together with a delayed in the age of presentation,which,in sum,lead to an increase in both incidence and prevalence of ACS with age,especially non-ST elevation myocardial infarction(NSTEMI).展开更多
Heart failure(HF)is a clinical syndrome caused by structural and/or functional cardiac abnormalities,resulting in a reduced cardiac output and/or elevated intracardiac filling pressures at rest or during stress.HF is ...Heart failure(HF)is a clinical syndrome caused by structural and/or functional cardiac abnormalities,resulting in a reduced cardiac output and/or elevated intracardiac filling pressures at rest or during stress.HF is a major public health problem with high prevalence and incidence,involving both high morbidity and mortality,but also high economic costs.The incidence of HF progressively increases with age,reaching around 20%among people over 75 years old.Indeed,HF represents the leading cause of hospitalization in patients older than 65 years in Western countries.Hence,some authors even consider HF a geriatric syndrome,entailing worse prognosis and high residual disability,and often associating some complex comorbidities,common in older population,that may further complicate the course of the disease.On the other hand,however,clinical course and prognosis may be often difficult to predict.In this article,main pathophysiological issues related to the aging heart are addressed,together with key aspects related to both diagnosis and prognosis in elderly patients with HF.Besides,main geriatric conditions,common in the elderly population,are reviewed,highlighting the importance of a comprehensive and multidisciplinary approach.展开更多
Cardiovascular risk factors(CVRF)are very prevalent in the elderly population and in addition to predisposing to cardiovascular disease they are related to functional decline,which limits the quality of life in this p...Cardiovascular risk factors(CVRF)are very prevalent in the elderly population and in addition to predisposing to cardiovascular disease they are related to functional decline,which limits the quality of life in this population.The objective of this work is to offer a review of the current evidence in the management of CVRF in the elderly population.The search strategy was executed in PubMed,Clinicalstrials.org and Embase,to search for clinical trials,observational cohort or cross-sectional studies,reviews,and clinical practice guidelines focused or including elderly population.The results provided were refined after reading the title and abstract,as well as elimination of duplicates,and were finally identified and assessed following the GRADE methodology.A total of 136 studies were obtained for all predefined risk factors,such as sedentary lifestyle,smoking,obesity and metabolic syndrome,hypertension,diabetes mellitus,dyslipidemia and alcohol.We described the results of the studies identified and assessed according to their methodological quality in different recommendation sections:diagnostic and prevention,intervention,or treatment in the elderly population.As the main limitation to the results of this review,there is the lack of quality studies whose target population is elderly patients.This issue limits the recommendations that can be made in this population.Due to this reason,comprehensive geriatric assessment seems the best tool currently available to implement the most appropriate treatment plans based on the baseline situation and comorbidity of each elderly patient.展开更多
In recent decades,life expectancy has been increasing significantly.In this scenario,health interventions are ne-cessary to improve prognosis and quality of life of elderly with cardiovascular risk factors and cardiov...In recent decades,life expectancy has been increasing significantly.In this scenario,health interventions are ne-cessary to improve prognosis and quality of life of elderly with cardiovascular risk factors and cardiovascular disease.However,the number of elderly patients included in clinical trials is low,thus current clinical practice guidelines do not include specific re-commendations.This document aims to review prevention recommendations focused in patients≥75 years with high or very high cardiovascular risk,regarding objectives,medical treatment options and also including physical exercise and their inclusion in cardiac rehabilitation programs.Also,we will show why geriatric syndromes such as frailty,dependence,cognitive impair-ment,and nutritional status,as well as comorbidities,ought to be considered in this population regarding their important pro-gnostic impact.展开更多
文摘Atrial fibrillation(AF)is the most common arrhythmia in elderly population,with age being one of the most important factors involved in its pathogenesis.Conduction disturbances may be present on the surface electrocardiogram before AF onset in some patients.Once this arrhythmia is diagnosed,antithrombotic therapy is mandatory in most cases,as this is the only treatment that has demonstrated to improve survival.Age increases both the risk of thromboembolic and bleeding complications,while benefits from anticoagulant therapy outweigh that from bleeding in most scenarios,also in very elderly patients.However,elderly patients with AF are often undertreated.Non-vitamin K antagonist oral anticoagulants have emerged as an alternative to vitamin K antagonists,with significant less adverse events and better profile in terms of efficacy and safety.Other conditions related to age should be carefully evaluated in these patients(including frailty,comorbidity and polypharmacy)to ensure an individualized clinical and therapeutic approach.
文摘1 Introduction Societies are ageing at an accelerated pace.This scenario is a well-known challenge for health care systems,as chronic diseases,multiple comorbidities and dependency are all entities that often converge in the elderly.Besides,there is an issue regarding a reduction in the general incidence of acute coronary syndrome(ACS)together with a delayed in the age of presentation,which,in sum,lead to an increase in both incidence and prevalence of ACS with age,especially non-ST elevation myocardial infarction(NSTEMI).
文摘Heart failure(HF)is a clinical syndrome caused by structural and/or functional cardiac abnormalities,resulting in a reduced cardiac output and/or elevated intracardiac filling pressures at rest or during stress.HF is a major public health problem with high prevalence and incidence,involving both high morbidity and mortality,but also high economic costs.The incidence of HF progressively increases with age,reaching around 20%among people over 75 years old.Indeed,HF represents the leading cause of hospitalization in patients older than 65 years in Western countries.Hence,some authors even consider HF a geriatric syndrome,entailing worse prognosis and high residual disability,and often associating some complex comorbidities,common in older population,that may further complicate the course of the disease.On the other hand,however,clinical course and prognosis may be often difficult to predict.In this article,main pathophysiological issues related to the aging heart are addressed,together with key aspects related to both diagnosis and prognosis in elderly patients with HF.Besides,main geriatric conditions,common in the elderly population,are reviewed,highlighting the importance of a comprehensive and multidisciplinary approach.
文摘Cardiovascular risk factors(CVRF)are very prevalent in the elderly population and in addition to predisposing to cardiovascular disease they are related to functional decline,which limits the quality of life in this population.The objective of this work is to offer a review of the current evidence in the management of CVRF in the elderly population.The search strategy was executed in PubMed,Clinicalstrials.org and Embase,to search for clinical trials,observational cohort or cross-sectional studies,reviews,and clinical practice guidelines focused or including elderly population.The results provided were refined after reading the title and abstract,as well as elimination of duplicates,and were finally identified and assessed following the GRADE methodology.A total of 136 studies were obtained for all predefined risk factors,such as sedentary lifestyle,smoking,obesity and metabolic syndrome,hypertension,diabetes mellitus,dyslipidemia and alcohol.We described the results of the studies identified and assessed according to their methodological quality in different recommendation sections:diagnostic and prevention,intervention,or treatment in the elderly population.As the main limitation to the results of this review,there is the lack of quality studies whose target population is elderly patients.This issue limits the recommendations that can be made in this population.Due to this reason,comprehensive geriatric assessment seems the best tool currently available to implement the most appropriate treatment plans based on the baseline situation and comorbidity of each elderly patient.
基金This work was funded by Instituto de Salud Carlos III and FEDER founds(Exp.JR/21/00041)。
文摘In recent decades,life expectancy has been increasing significantly.In this scenario,health interventions are ne-cessary to improve prognosis and quality of life of elderly with cardiovascular risk factors and cardiovascular disease.However,the number of elderly patients included in clinical trials is low,thus current clinical practice guidelines do not include specific re-commendations.This document aims to review prevention recommendations focused in patients≥75 years with high or very high cardiovascular risk,regarding objectives,medical treatment options and also including physical exercise and their inclusion in cardiac rehabilitation programs.Also,we will show why geriatric syndromes such as frailty,dependence,cognitive impair-ment,and nutritional status,as well as comorbidities,ought to be considered in this population regarding their important pro-gnostic impact.
