How Pharmacists Can Help Manage ACS in the Elderly

Acute coronary syndrome (ACS) is clearly a problem in the elderly population, especially since survival declines with increasing age.

Men experience their first myocardial infarction (MI) around age 65, but that initial event is more likely to occur about 7 years later for women, at around age 72. Those who have a first MI after age 75 have life expectancies of just 3.2 years.

A team of pharmacy academics recently published a review in The Consultant Pharmacist that targeted management strategies for ACS in the elderly

These authors compiled and evaluated a comprehensive file of available information on managing elderly ACS patients. They noted clinical trial protocols often exclude these patients due to advanced age, multiple comorbidities, or concurrent medications, which leads to under-representation of this high-risk group.

Furthermore, the definition of “elderly” is poorly defined. The pharmacy academics addressed this issue by including all related studies in their review, regardless of age cutoff.

They noted pharmacists are valuable team players in ACS, as pharmacist-led interventions have been shown to improve the proportion of treatment-adherent elderly patients by approximately 15%.

These interventions also demonstrated improvement in adherence to a combination of 4 cardioprotective medications fundamental to longer survival: statins, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers, and clopidogrel.

Other key findings of the review included:

· Elderly post-ACS patients generally respond to the same medications and interventions as younger patients do.

· Although elderly ACS patients are less likely to receive guideline-recommended therapies, their need for these treatments is equal to if not greater than that of younger patients.

· Elderly ACS patients may be at higher risk for some side effects. Although the authors cited bleeding with prasugrel and hypotension with beta-blockers as examples, they stressed that clinical benefits typically outweigh risks for most medications used to treat ACS.

· Reducing polypharmacy is a critical role for pharmacists, but it can be challenging, due to ACS patients’ large pill burden and need for drug treatment for comorbidities.