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Geriatric Medicine

Cardiology   

Questions discussed in this category

What would be your approach for the management of asymptomatic, severe AS with a peak velocity of 5 m/s in an otherwise physically active patient in their mid-90s without significant co-morbidities?
3 Answers available
What is your clinical approach to deprescribing vs continuing low-dose aspirin used for primary prevention in older adults who are already taking this medication?
Are there any pearls for strong factors that would push you towards vs away from deprescribing?
1 Answer available
Have you changed your approach to delaying hip surgery in the context of decompensated CHF given the findings of the HIP-ATTACK study?
HIP ATTACK Investigators, PMID 32050090 
1 Answer available
Which anticoagulant (DOAC or Warfarin) would you recommend in the case of a 70-year-old male with persistent atrial fibrillation and history of rheumatic mitral stenosis now status post bioprosthetic MVR?
1 Answer available
How are you incorporating the newer RCT data suggesting no mortality benefit to indefinite beta-blocker therapy for patients who are several years out from an MI with preserved LVEF and no angina or arrhythmia?
As per the REDUCE-AMI trial. Are you routinely de-prescribing, selectively stopping based on symptoms or risk profile, or still continuing by def...
1 Answer available
Do you recommend starting a statin in patients above 75 years old with diabetes but no known ASCVD?
3 Answers available
Would you consider transitioning patients older than 75 years of age with coronary disease from statins and/or other lipid-lowering agents to PCSK9 inhibitors given concerns for polypharmacy, provided their LDL levels remain at or below goal?
2 Answers available
How do you approach the management of extremely low LDL levels in older adult patients receiving statin therapy for primary prevention of cardiovascular disease?
1 Answer available
For patients over 70 with elevated ASCVD risk but no prior cardiovascular events, do you ever recommend continuing or initiating low-dose aspirin?
Aspirin Use to Prevent Cardiovascular Disease: Preventive Medication
1 Answer available
What is your systolic blood pressure target for patients over 80 with frailty and multiple comorbidities?
1 Answer available
For elderly patients (i.e. older than 80) with only one documented episode of paroxysmal atrial fibrillation following a stress event (such as acute illness/steroid administration) and a CHADsVASc score greater than 1, how would you counsel them on the risks/benefits of anticoagulation and subsequent monitoring for afib recurrence?
6 Answers available
Is there any benefit in maintaining statin or aspirin therapy in patients >75 years old with stable, multivessel ischemic heart disease in light of challenges encountered with polypharmacy?
2 Answers available
For patients over 90 years old, is there any foreseeable benefit to undergoing left atrial appendage occlusion over permanent cessation of anticoagulation, particularly for those at high risk for major bleeding?
2 Answers available
What is your approach to a newly diagnosed LBBB in individuals >70 years old who are free of any signs or symptoms of heart disease and without other significant ASCVD risk factors besides age?
If the ECG was obtained prior to major orthopedic surgery (such as hip replacement) would that change your approach?
3 Answers available
How do you approach revascularization in patients over 75 years with NSTEMI, given recent evidence from the SENIOR-RITA trial that an invasive strategy does not significantly reduce cardiovascular events compared to a conservative strategy?
Kunadian, et al., PMID 39225274
1 Answer available
Would you recommend PFO closure in patients >60 years old with presumed paradoxical embolism as their mechanism of stroke?
2 Answers available
Given the "LDL Paradox", in which RA patients with the highest levels of inflammation can have ultra-low levels of LDL (<70), how do you approach initiation of statin therapy in these patients?
Dr. Charles-Schoeman presented data at ACR 21 showing that, paradoxically, there is a U-shaped relationship between inflammation and LDL levels in pat...
1 Answer available


Papers discussed in this category

The New England journal of medicine, 2013-03-21
Closure of patent foramen ovale versus medical therapy after cryptogenic stroke.
Neurology, 2013-08-13
An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke.
The New England journal of medicine, 2017-09-14
Long-Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke.
Circ Cardiovasc Interv, 2022 Jun 23
Transcatheter Closure of Patent Foramen Ovale in Older Patients With Cryptogenic Thromboembolic Events.
JAMA, 2021 Dec 14
Heterogeneity of Treatment Effects in an Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale After Stroke.
JAMA Neurol, 2020 Jul 01
Proposal for Updated Nomenclature and Classification of Potential Causative Mechanism in Patent Foramen Ovale-Associated Stroke.
JAMA Neurol, 2022 Nov 01
Association of Atrial Septal Aneurysm and Shunt Size With Stroke Recurrence and Benefit From Patent Foramen Ovale Closure.
Circulation, 2016-11-22
Recommendations for Management of Clinically Significant Drug-Drug Interactions With Statins and Select Agents Used in Patients With Cardiovascular Disease: A Scientific Statement From the American Heart Association.
JAMA, 2022 Apr 26
Aspirin Use to Prevent Cardiovascular Disease: US Preventive Services Task Force Recommendation Statement.
The New England journal of medicine, 2024 Sep 01
Invasive Treatment Strategy for Older Patients with Myocardial Infarction.
The New England journal of medicine, 2013-11-28
Edoxaban versus warfarin in patients with atrial fibrillation.
The New England journal of medicine, 2011-09-15
Apixaban versus warfarin in patients with atrial fibrillation.
The New England journal of medicine, 2011 Aug 10
Rivaroxaban versus warfarin in nonvalvular atrial fibrillation.
The New England journal of medicine, 2024 Oct 28
Transcatheter Aortic-Valve Replacement for Asymptomatic Severe Aortic Stenosis.
Drugs & aging, 2001
Hypertension in the Very Elderly Trial (HYVET): protocol for the main trial.
Circulation research, 2019 Mar 29
Hypertension Management in Older and Frail Older Patients.
Circulation, 2024 Sep 24
2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
Lancet (London, England), 2020 Feb 09
Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial.
The Journal of bone and joint surgery. American volume, 2024 Jul 25
Myocardial Injury in Patients with Hip Fracture: A HIP ATTACK Randomized Trial Substudy.

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