cardiovascular problems in elderly
TRANSCRIPT
Cardiovascular diseases in Elderly
Dr. Md.Toufiqur Rahman
MBBS, FCPS, MD, FACC, FESC, FRCPE, FSCAI,
FAPSC, FAPSIC, FAHA, FCCP, FRCPG
Associate Professor of CardiologyNational Institute of Cardiovascular Diseases(NICVD),
Sher-e-Bangla Nagar, Dhaka-1207
Consultant, Medinova, Malibagh branch
Honorary Consultant, Apollo Hospitals, Dhaka and
STS Life Care Centre, [email protected]
CRT 2014Washington
DC, USA
Introduction
• Cardiovascular disease is the most frequent diagnosis in elderly people and is the leading cause of death in both men and women older than 65 years of age.
• Hypertension occurs in one half to two thirds of people older than 65 years of age, and heart failure (HF) is the most frequent hospital discharge diagnosis among older Americans.
• The profile of these common cardiovascular diseases differs in older patients from that in younger patients.
• Systolic, but not diastolic, blood pressure increases with aging, resulting in increased pulse pressure.
• Systolic hypertension becomes a stronger predictor of cardiovascular events, especially in women.
• Heart failure with preserved systolic function becomes more common at older ages and is more common in women.
• Coronary artery disease (CAD) is more likely to involve multiple vessels and left main artery disease and is equally likely in women as in men older than 65 years of age.
• Equal numbers of older men and women present with acute myocardial infarction (MI) until age 80, after which more women present.
• More than 80 percent of all deaths attributable to cardiovascular disease occur in people older than 65 years with approximately 60 percent of deaths in patients older than 75 years.
Introduction
Prevalence of cardiovascular and other common chronic medical illnesses in older persons in the United States. Data are percentages. Blue bars represent data for men older than 65 years,
pink bars represent women older than 65 years, and yellow bars represent men and women older than 80 years. AF = atrial fibrillation; CAD = coronary artery disease; CVD =
cardiovascular disease; HF = heart failure; BP = hypertension (all forms); PAD = peripheral artery disease. [email protected]
U.S. population estimates projected from 2000 until 2050. Dark pink bars represent numbers of women older than 65 years. Dark blue bars represent men older than 65 years. Light pink bars represent numbers of women older than 85 years. Light blue bars represent numbers of men older than 85 years in millions
Prevalence of cardiovascular and other common chronic medical illnesses in older persons in the United States. Data are percentages. Blue bars represent data for men older than 65 years, pink bars represent women older than 65 years, and yellow bars represent men and women older than 80 years. AF =
atrial fibrillation; CAD = coronary artery disease; CVD = cardiovascular disease; HF = heart failure; BP = hypertension (all forms); PAD = peripheral artery
disease.
Differentiation Between Age-Associated Changes and Cardiovascular Disease in Older People
Guidelines for Medication Prescribing in Older Patients
• In general, loading doses should be reduced—weight (or body surface area) can be used to estimate loading dose requirements; doses in women are usually less than in men.
• Use estimates of glomerular filtration to guide dosing of renally cleared medications and contrast administration; reduce doses of metabolically or hepatically cleared drugs.
• Time between dosage adjustments and evaluation of dosing changes should be longer in older patients than younger patients.
• Routine use of strategies to avoid drug interactions is essential—incorporating reference materials, a team approach, and quality improvement initiatives are effective strategies.
• Knowledge of effects of noncardiac medications is necessary. • Assessment of adherence and attention to factors contributing to
nonadherence should be part of the prescribing process. • Physicians must be familiar with the patient's source of prescription
medication coverage including Medicare D legislation and provide patient education and assistance with obtaining critical medications.
• Multidisciplinary approaches to monitoring medication therapy may increase successful outcomes of medication therapy.
The relationship between the number of drugs consumed and drug interactions. Current guidelines for the pharmacological management of patients with heart failure (HF) or myocardial infarction (post MI)
place them at high risk for drug interactions.
Estimation of 4-Year Mortality in the Elderly Using Medical and Functional Information
Thank [email protected]
Asia Pacific Congress of Hypertension, 2014, February
Cebu city, Phillipines
Seminar on Management of Hypertension,
Gulshan, Dhaka