Challenges in the management of older patients with acute coronary syndromes in the COVID-19 pandemic.
Identifieur interne : 000233 ( Main/Corpus ); précédent : 000232; suivant : 000234Challenges in the management of older patients with acute coronary syndromes in the COVID-19 pandemic.
Auteurs : Ben Rowland ; Vijay KunadianSource :
- Heart (British Cardiac Society) [ 1468-201X ] ; 2020.
Abstract
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.
DOI: 10.1136/heartjnl-2020-317011
PubMed: 32444504
PubMed Central: PMC7253225
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Challenges in the management of older patients with acute coronary syndromes in the COVID-19 pandemic.</title><author><name sortKey="Rowland, Ben" sort="Rowland, Ben" uniqKey="Rowland B" first="Ben" last="Rowland">Ben Rowland</name><affiliation><nlm:affiliation>Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Cardiothoracic Centre, Freeman Hospital, Newcastle Upon Tyne, UK.</nlm:affiliation></affiliation></author><author><name sortKey="Kunadian, Vijay" sort="Kunadian, Vijay" uniqKey="Kunadian V" first="Vijay" last="Kunadian">Vijay Kunadian</name><affiliation><nlm:affiliation>Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK vijay.kunadian@newcastle.ac.uk.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Cardiothoracic Centre, Freeman Hospital, Newcastle Upon Tyne, UK.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32444504</idno><idno type="pmid">32444504</idno><idno type="doi">10.1136/heartjnl-2020-317011</idno><idno type="pmc">PMC7253225</idno><idno type="wicri:Area/Main/Corpus">000233</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000233</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Challenges in the management of older patients with acute coronary syndromes in the COVID-19 pandemic.</title><author><name sortKey="Rowland, Ben" sort="Rowland, Ben" uniqKey="Rowland B" first="Ben" last="Rowland">Ben Rowland</name><affiliation><nlm:affiliation>Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Cardiothoracic Centre, Freeman Hospital, Newcastle Upon Tyne, UK.</nlm:affiliation></affiliation></author><author><name sortKey="Kunadian, Vijay" sort="Kunadian, Vijay" uniqKey="Kunadian V" first="Vijay" last="Kunadian">Vijay Kunadian</name><affiliation><nlm:affiliation>Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK vijay.kunadian@newcastle.ac.uk.</nlm:affiliation></affiliation><affiliation><nlm:affiliation>Cardiothoracic Centre, Freeman Hospital, Newcastle Upon Tyne, UK.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Heart (British Cardiac Society)</title><idno type="eISSN">1468-201X</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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.</div></front></TEI><pubmed><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">32444504</PMID><DateRevised><Year>2020</Year><Month>06</Month><Day>03</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1468-201X</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2020</Year><Month>May</Month><Day>22</Day></PubDate></JournalIssue><Title>Heart (British Cardiac Society)</Title><ISOAbbreviation>Heart</ISOAbbreviation></Journal><ArticleTitle>Challenges in the management of older patients with acute coronary syndromes in the COVID-19 pandemic.</ArticleTitle><ELocationID EIdType="pii" ValidYN="Y">heartjnl-2020-317011</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1136/heartjnl-2020-317011</ELocationID><Abstract><AbstractText>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.</AbstractText><CopyrightInformation>© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Rowland</LastName><ForeName>Ben</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Cardiothoracic Centre, Freeman Hospital, Newcastle Upon Tyne, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kunadian</LastName><ForeName>Vijay</ForeName><Initials>V</Initials><Identifier Source="ORCID">http://orcid.org/0000-0003-2975-6971</Identifier><AffiliationInfo><Affiliation>Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK vijay.kunadian@newcastle.ac.uk.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Cardiothoracic Centre, Freeman Hospital, Newcastle Upon Tyne, UK.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016454">Review</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>05</Month><Day>22</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Heart</MedlineTA><NlmUniqueID>9602087</NlmUniqueID><ISSNLinking>1355-6037</ISSNLinking></MedlineJournalInfo><CitationSubset>AIM</CitationSubset><CitationSubset>IM</CitationSubset><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">acute coronary syndromes</Keyword><Keyword MajorTopicYN="N">cardiac catheterisation and angiography</Keyword><Keyword MajorTopicYN="N">coronary artery disease</Keyword></KeywordList><CoiStatement>Competing interests: None declared.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate 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