September 2007

An 83-year-old woman with ischemic cardiomyopathy and a left ventricular ejection fraction of 27% was hospitalized with increasing shortness of breath and lower extremity edema.

An 84-year-old woman was admitted to the hospital because of fever, wheezing, and shortness of breath.

The increasing prevalence of atrial fibrillation in the elderly, especially compared with younger age groups, is striking (8% in persons > 80 years compared with 1% in those < 60 years).

After an acute coronary syndrome (ACS) event, elderly patients are at greater risk of death and nonfatal coronary events compared with younger patients. Despite this, elderly patients continue to receive less evidence-based therapy. Lipidlowering therapy with statins is now routine practice for the secondary prevention of coronary heart disease. Achieving the optional National Cholesterol Expert Panel goal of a low-density lipoprotein cholesterol level of < 70 mg/dL for ACS patients over 70 years of age could prevent nearly 80 deaths or nonfatal coronary events for every 1000 patients treated for 2 years with a number needed to treat of approximately 12.

Elderly patients with a history of an acute coronary syndrome (ACS) are at higher risk for subsequent cardiovascular events than younger patients.

Over a period of 14 years, we followed 282 patients aged 70 years or older who were hospitalized with heart failure. Median survival was 2.5 years, but 25% of patients died within 1 year, and 25% survived for at least 5 years following hospital discharge. A simple 7-item risk score based on data readily available at the time of hospitalization effectively stratified patients into low-, intermediate-, and high-risk categories for subsequent mortality.

Congestive heart failure does not necessarily "go away" in the elderly.

Anomalous coronary arteries are rare congenital cardiac defects with varying symptomatology and controversial clinical significance. These should be considered as a differential diagnosis, particularly when coronary schemia occurs in a child or young adult.

Recent observational studies have suggested that statins have a protective effect against cancer. However, long-term statin users were shown to be healthier, less frail, and more adherent to therapy and screenings. We conducted a cohort study to evaluate the effect of statins on several common cancers in a large elderly population.

There has been an epidemiologic association of low total cholesterol levels with increased risk of cancer noted for several decades.

We assessed the pattern of use and the effectiveness of antithrombotic therapy in a cohort of high-risk elderly patients hospitalized for atrial fibrillation, with data derived from prescription, hospitalization, and mortality databases from 3 linked registries. Results showed that antithrombotic therapy was underused, even in patients with no comorbid conditions. In addition, patients exposed to antithrombotic therapy had a significantly lower mortality rate. The collection of epidemiological data by record linkage represents a flexible and readily available tool for monitoring and improving routine clinical care.