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2020 ; 106
(17
): 1296-1301
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Challenges in the management of older patients with acute coronary syndromes in
the COVID-19 pandemic
#MMPMID32444504
Rowland B
; Kunadian V
Heart
2020[Sep]; 106
(17
): 1296-1301
PMID32444504
show ga
Ischaemic heart disease (IHD), in particular acute coronary syndrome (ACS),
comprising ST-elevation myocardial infarction, non-ST-elevation myocardial
infarction and unstable angina, is the leading cause of death worldwide. Age is a
major predictor of adverse outcome following ACS. COVID-19 infection seems to
escalate the risk in older patients with heart disease. Increasing odds of
in-hospital death is associated with older age following COVID-19 infection.
Importantly, it seems older patients with comorbidities such as cardiovascular
disease (CVD), in particular IHD, diabetes and hypertension, are at the highest
risk of mortality following COVID-19 infection. The evidence is sparse on the
optimal care of older patients with ACS with lack of robust randomised controlled
trials. In this setting, with the serious threat imposed by the COVID-19 pandemic
in the context of rapidly evolving knowledge with much unknown, it is important
to weigh the risks and benefits of treatment strategies offered to older
patients. In cases where risks outweigh the benefits, it might not be an
unreasonable option to treat such patients with a conservative or a palliative
approach. Further evidence to elucidate whether invasive management is beneficial
in older patients with ACS is required out-with the COVID-19 pandemic. Though it
is hoped that the actual acute phase of COVID-19 infection will be short lived,
it is vital that important clinical research is continued, given the long-term
benefits of ongoing clinical research for patients with long-term conditions,
including CVD. This review aimed to evaluate the challenges and the management
strategies in the care of older patients presenting with ACS in the context of
the COVID-19 pandemic.
|*Coronavirus Infections/epidemiology/prevention & control
[MESH]
|*Pandemics/prevention & control
[MESH]
|*Pneumonia, Viral/epidemiology/prevention & control
[MESH]