Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Asturias, Spain.
Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, 46010 Valencia, Spain.
Rev Cardiovasc Med. 2022 Feb 11;23(2):55. doi: 10.31083/j.rcm2302055.
Acute coronary syndrome (ACS) is one of the main causes of mortality and morbidity in the elderly. The prevalence of ACS increases with age and patients with advanced age have some co-morbidities that require an individualized approach, which includes a comprehensive geriatric assessment. Ageism is a matter of great concern. In this scenario, some ethical conflicts may arise which should be anticipated, considered, and solved. Clinicians will need to prioritize and allocate resources, to avoid futility/proportionality, which is not always easy to assess in these patients. This review aims to summarize the evidence regarding ethical conflicts that may arise in the management of patients with ACS and advanced age. We will discuss how to choose the best option (which frequently is not the only one) with the lowest risk for harm, considering and respecting the patients' decision. The four basic principles of bioethics (beneficence, non-maleficence, autonomy, and justice) are thoroughly reviewed, and discussed, regarding their role in the decision making process.
急性冠状动脉综合征（ACS）是老年人死亡和发病的主要原因之一。ACS 的患病率随年龄增长而增加，老年患者存在一些合并症，需要采取个体化方法，包括全面的老年评估。年龄歧视是一个值得关注的问题。在这种情况下，可能会出现一些需要预见、考虑和解决的伦理冲突。临床医生需要优先考虑和分配资源，以避免在这些患者中评估并不总是容易的无效/比例性。本综述旨在总结在管理 ACS 和高龄患者时可能出现的伦理冲突的证据。我们将讨论如何选择风险最低、伤害最小的最佳选择（通常不是唯一选择），同时考虑并尊重患者的决策。我们将深入审查和讨论生物伦理学的四项基本原则（即有益、不伤害、自主和公正）在决策过程中的作用。
