The elderly acute coronary syndrome patient: a neglected population?

Introduction

Cardiovascular disease is the commonest cause of death in the elderly (>75 years). The elderly acute coronary syndrome (ACS) patient forms a particular high-risk cohort. Clinical trials traditionally concentrate on younger patients for both ACS treatment strategies and secondary prevention, despite the elderly being the fastest growing section of the population. The literature suggests the elderly do not receive appropriate therapy in this setting. What is the current UK experience?

Objective and method

To assess the secondary preventative treatment received by the elderly ACS patient. Retrospective analysis of our Myocardial Infarction National Audit Project (MINAP) database 2003–2006. Patients were divided into three age groups: <50 years, 50–75 years and >75 years old. Data were collected from hospital admission to discharge.

Results

A total of 1,501 consecutive patients were included in the analysis, 530 patients (35.3%) were >75 years, mean age 83.6 years (± 5.1). The discharge diagnosis was ST elevation myocardial infarction in 619, UA/NSTEMI in 870 and unspecified in 12 patients. The overall inpatient all-cause mortality rate was 8.06% (121/1,501). See Table 1.

Table 1

Conclusion

The elderly ACS patient forms a high-risk group. The therapeutic approach in this group should be justifiably as aggressive as that in younger patients, balancing risks with benefits. The elderly patient should be prescribed secondary preventative measures, and our data show considerably greater numbers can benefit from standard treatment than suggested by the published literature.