Nanna Michael G, Sutton Nadia R, Kochar Ajar, Rymer Jennifer A, Lowenstern Angela M, Gackenbach Grace, Hummel Scott L, Goyal Parag, Rich Michael W, Kirkpatrick James N, Krishnaswami Ashok, Alexander Karen P, Forman Daniel E, Bortnick Anna E, Batchelor Wayne, Damluji Abdulla A
Yale University School of Medicine, New Haven, Connecticut, USA.
Department of Internal Medicine, Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, Michigan, USA.
JACC Adv. 2023 Jul;2(5). doi: 10.1016/j.jacadv.2023.100421. Epub 2023 Jul 28.
We review a comprehensive risk assessment approach for percutaneous coronary interventions in older adults and highlight the relevance of geriatric syndromes within that broader perspective to optimize patient-centered outcomes in interventional cardiology practice. Reflecting the influence of geriatric principles in older adults undergoing percutaneous coronary interventions, we propose a "geriatric" heart team to incorporate the expertise of geriatric specialists in addition to the traditional heart team members, facilitate uptake of the geriatric risk assessment into the preprocedural risk assessment, and address ways to mitigate these geriatric risks. We also address goals of care in older adults, highlighting common priorities that can impact shared decision making among older patients, as well as frequently encountered pharmacotherapeutic considerations in the older adult population. Finally, we clarify gaps in current knowledge and describe crucial areas for future investigation.
我们回顾了针对老年人经皮冠状动脉介入治疗的综合风险评估方法，并强调了在这一更广泛背景下老年综合征的相关性，以优化介入心脏病学实践中以患者为中心的治疗结果。为反映老年医学原则对接受经皮冠状动脉介入治疗的老年人的影响，我们提议组建一个“老年医学”心脏团队，除了传统心脏团队成员外，纳入老年医学专家的专业知识，促进将老年医学风险评估纳入术前风险评估，并探讨减轻这些老年医学风险的方法。我们还讨论了老年人的护理目标，强调了可能影响老年患者共同决策的常见优先事项，以及老年人群中经常遇到的药物治疗考虑因素。最后，我们阐明了当前知识的差距，并描述了未来研究的关键领域。
