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Am J Med. 2017 Oct;130(10):1144-1147. doi: 10.1016/j.amjmed.2017.05.043. Epub 2017 Jul 4.

Contextualizing Myocardial Infarction: Comorbidities and Priorities in Older Adults.

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Division of Cardiology, Kaiser Permanente San Jose Medical Center, San Jose, Calif; Department of Epidemiology and Biostatistics, University of California, San Francisco, Calif. Electronic address:
Division of Cardiology, Columbia University Medical Center, New York, NY.
Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, NC.


Cardiovascular care for older adults has become increasingly complex owing to a rise in the concurrent comorbidity burden that accompanies senescence. Internists, hospitalists, and cardiologists often encounter geriatric patients with multiple chronic conditions needing acute cardiovascular care. Abnormal cardiac biomarker levels in patients with multiple noncardiac conditions are a common reason for older adults to enter the hospital. This type of acute coronary syndrome, defined as a non-ST segment elevation myocardial infarction or, more precisely, type 2 myocardial infarction, often leads to substantial consternation. Although guideline-based single-disease care may be appropriate in younger individuals, a more cautious approach is needed when considering optimal care strategies for older adults. We discuss a case of an older adult presenting with type 2 myocardial infarction, to highlight a modern-day approach that requires a deliberate shift from an evidence-based focus to a more value-based geriatric mindset.


Cardiovascular care; Older adults; Value-based geriatric care

[Indexed for MEDLINE]

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