Literature

Curbside Consults Podcast

Management of Acute Coronary Syndrome in Older Adults with Dr. Abdulla Damluji

By Clement Lee, MD, MSc

Published April 5, 2023

In this episode of Curbside Consults, we examine the 2022 scientific statement from the American Heart Association on the management of acute coronary syndrome in the older adult population. We are joined by Dr. Abdulla Damluji, the lead author on the scientific statement. Dr. Damluji is an interventional cardiologist at Inova Heart and Vascular Institute and Associate Professor of Medicine at Johns Hopkins University School of Medicine.

00:05 – Intro
00:51 – American Heart Association (AHA) scientific statement process
02:16 – Defining acute coronary syndromes (ACS)
03:39 – Defining older adults
04:35 – Cardiovascular and other changes that occur in older adults
07:24 – Geriatric syndromes
10:55 – ACS symptoms in older adults
12:20 – Troponins in older adults
13:42 – The electrocardiogram (ECG) in older adults
15:34 – Percutaneous coronary intervention (PCI) in older adults
19:17 – Coronary artery bypass grafting (CABG) in older adults
20:36 – DNR/I (do not resuscitate/intubate) orders
22:15 – Ticagrelor versus clopidogrel in older adults
23:51 – Management of concurrent atrial fibrillation
25:12 – Cardiac rehabilitation
26:48 – Transitions of care
28:30 – Concluding remarks
29:03 – Outro

Articles discussed in this episode:

1. Damluji AA et al. Management of Acute Coronary Syndrome in the Older Adult Population: A Scientific Statement from the American Heart Association. Circulation 2023.

2. Alexander KP et al. Acute Coronary Care in the Elderly, Part I: Non-ST-Segment-Elevation Acute Coronary Syndromes: A Scientific Statement for Healthcare Professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation 2007.

3. Alexander KP et al. .Acute Coronary Care in the Elderly, Part II: ST-Segment-Elevation Myocardial Infarction: A Scientific Statement for Healthcare Professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation 2007.

4. Savonitto S et al. Early Aggressive Versus Initially Conservative Treatment in Elderly Patients with Non-ST-Segment Elevation Acute Coronary Syndrome: A Randomized Controlled Trial. JACC Cardiovasc Interv 2012.

5. Tegn N et al. Early Aggressive Versus Initially Conservative Treatment in Elderly Patients with Non-ST-Segment Elevation Acute Coronary Syndrome: A Randomized Controlled Trial. Lancet 2016.

6. Sanchis J et al Randomized Comparison Between the Invasive and Conservative Strategies in Comorbid Elderly Patients with Non-ST Elevation Myocardial Infarction. Eur J Intern Med 2016.

7. Kitzman DW et al. Physical Rehabilitation for Older Patients Hospitalized for Heart Failure. N Engl J Med 2021.

The Curbside Consults series complements the foundational information in Rotation Prep by taking a deep dive into key clinical topics with expert clinicians and educators. These podcasts explore and critique the evidence behind clinical practice and break down statistical concepts for the busy clinical trainee.

res360
Abdulla Damluji, MD, is the lead author on the scientific statement discussed in this Curbside Consult. Dr. Damluji is an interventional cardiologist at Inova Heart and Vascular Institute and Associate Professor of Medicine at Johns Hopkins University School of Medicine.
res360
Clement Lee, MD, MSc, was a 2021–2022 NEJM Editorial Fellow and is a 2022-2023 Senior Editorial Fellow. He is currently an internal medicine hospitalist at Newton-Wellesley Hospital and a pediatric hospitalist at Boston Children's Hospital. He completed his internal medicine-pediatrics residency at Penn-CHOP.