Theodorakis Nikolaos, Hitas Christos, Vamvakou Georgia, Kalantzi Sofia, Spyridaki Aikaterini, Kollia Zoi, Feretzakis Georgios, Nikolaou Maria
Department of Cardiology, Sismanogleio-Amalia Fleming General Hospital, 14 25is Martiou Str., 15127 Melissia, Greece.
Geriatric Outpatient Clinic, Sismanogleio-Amalia Fleming General Hospital, 14 25is Martiou Str., 15127 Melissia, Greece.
J Geriatr Cardiol. 2025 Jan 28;22(1):190-209. doi: 10.26599/1671-5411.2025.01.004.
Cardiovascular diseases (CVD) are undoubtedly the leading cause of morbidity and mortality in the elderly. Population aging is a global phenomenon. In developed countries, by the year 2050 one in four people will be aged 65+ years. This ongoing growth of the aging population leads to an increasing burden of CVD. The management of CVD in geriatric patients requires specific considerations. Aging is associated with complex pathophysiology due to decreased organ reserve, which is clinically described as frailty. Additionally, the aging population is extremely heterogenous and frequently characterized by a combination of unique features, including atypical disease presentation, multimorbidity, polypharmacy, altered pharmacokinetics, cognitive impairment, renal impairment, dysautonomia, elevated risk of falls, sarcopenia, and frailty. Furthermore, significant gaps in evidence exist largely due to the limited representation of the very elderly, and especially frail patients, in randomized controlled trials. When combined with issues related to life expectancy, goals of care, bioethics, and patients' preferences, these factors pose intricate challenges for healthcare providers. This literature review summarizes selected clinical scenarios that often introduce dilemmas in the management of elderly patients in cardiology practice, emphasizing the intersection of geriatric medicine and cardiology. These include blood pressure management, management of dyslipidemia, anticoagulation in atrial fibrillation, medical and device treatment of heart failure, antiplatelet and interventional management of acute coronary syndromes, and peri-procedural considerations in severe aortic stenosis. The above will provide guidance for clinical practice, as well as implications for health policies and future research in the field of geriatric cardiology.
心血管疾病（CVD）无疑是老年人发病和死亡的主要原因。人口老龄化是一种全球现象。在发达国家，到2050年，每四个人中就有一个年龄在65岁及以上。老年人口的持续增长导致心血管疾病负担日益加重。老年患者心血管疾病的管理需要特殊考虑。由于器官储备减少，衰老与复杂的病理生理学相关，临床上称之为衰弱。此外，老年人群极其多样化，其特征往往是多种独特特征的组合，包括非典型疾病表现、多病共存、多种药物治疗、药代动力学改变、认知障碍、肾功能损害、自主神经功能障碍、跌倒风险增加、肌肉减少症和衰弱。此外，由于随机对照试验中老年人群，尤其是衰弱患者的代表性有限，证据存在重大差距。当与预期寿命、护理目标、生物伦理学和患者偏好等问题结合起来时，这些因素给医疗服务提供者带来了复杂的挑战。这篇文献综述总结了在心脏病学实践中管理老年患者时经常带来困境的特定临床场景，强调老年医学与心脏病学的交叉点。这些包括血压管理、血脂异常管理、心房颤动的抗凝治疗、心力衰竭的药物和器械治疗、急性冠状动脉综合征的抗血小板和介入管理，以及重度主动脉瓣狭窄的围手术期考虑。以上内容将为临床实践提供指导，并对老年心脏病学领域的卫生政策和未来研究产生影响。
