Contextualizing Myocardial Infarction: Comorbidities and Priorities in Older Adults

Am J Med. 2017 Oct;130(10):1144-1147. doi: 10.1016/j.amjmed.2017.05.043. Epub 2017 Jul 4.

Abstract

Cardiovascular care for older adults has become increasingly complex owing to a rise in the concurrent comorbidity burden that accompanies senescence. Internists, hospitalists, and cardiologists often encounter geriatric patients with multiple chronic conditions needing acute cardiovascular care. Abnormal cardiac biomarker levels in patients with multiple noncardiac conditions are a common reason for older adults to enter the hospital. This type of acute coronary syndrome, defined as a non-ST segment elevation myocardial infarction or, more precisely, type 2 myocardial infarction, often leads to substantial consternation. Although guideline-based single-disease care may be appropriate in younger individuals, a more cautious approach is needed when considering optimal care strategies for older adults. We discuss a case of an older adult presenting with type 2 myocardial infarction, to highlight a modern-day approach that requires a deliberate shift from an evidence-based focus to a more value-based geriatric mindset.

Keywords: Cardiovascular care; Older adults; Value-based geriatric care.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Acute Coronary Syndrome / complications
  • Acute Coronary Syndrome / diagnosis
  • Aged
  • Aged, 80 and over
  • Comorbidity
  • Female
  • Humans
  • Myocardial Infarction / complications*
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / therapy
  • Non-ST Elevated Myocardial Infarction / complications
  • Non-ST Elevated Myocardial Infarction / diagnosis
  • Non-ST Elevated Myocardial Infarction / therapy