Cardiovascular Disease and Health in the Older Patient: Expanded from ‘Pathy's Principles and Practice of Geriatric Medicine’, Fifth edition

421 Pages·2012·2.816 MB·English

Cardiovascular Disease and Health in the
Older Patient
Expanded from ‘Pathy’s Principles and Practice of
Geriatric Medicine, Fifth edition edited by Alan J.
Sinclair, John E. Morley and Bruno Vellas’
Cardiovascular Disease and
Health in the Older Patient
Expanded from ‘Pathy’s Principles
and Practice of Geriatric Medicine,
Fifth edition edited by Alan J.
Sinclair, John E. Morley and
Bruno Vellas’
EDITEDBY
David J. Stott
InstituteofCardiovascularandMedicalSciences
UniversityofGlasgow,GlasgowRoyalInfirmary
Glasgow,Scotland,UK
Gordon D.O. Lowe
InstituteofCardiovascularandMedicalSciences
UniversityofGlasgow,GlasgowRoyalInfirmary
Glasgow,Scotland,UK
FOREWORDBYSTUARTM.COBBE,UNIVERSITYOFGLASGOW
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LibraryofCongressCataloging-in-PublicationData
Cardiovasculardiseaseandhealthintheolderpatient:expandedfrom‘Pathy’sPrinciplesand
practiceofgeriatricmedicine’/[editedby]DavidStottandGordonLowe. –1sted.
p.;cm.
Includesbibliographicalreferencesandindex.
ISBN978-0-470-97372-1(hardback:alk.paper)
I.Stott,David,1959-II.Lowe,G.D.O.(GordonDouglasOgilvie),1949-III.Pathy’sprinciples
andpracticeofgeriatricmedicine.
[DNLM:1.CardiovascularDiseases–therapy.2.Aged.WG120]
(cid:2)
618.9761–dc23
2012021981
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FirstImpression2013
Contents
ListofContributors,vii
Foreword,ix
Introduction,xi
1 EpidemiologyofHeartDisease,1
AhmedH.Abdelhafiz
2 CardiacAgeingandSystemicDisorders,29
DavidJ.StottandTerenceJ.Quinn
3 Hypertension,44
AnthonyS.WierzbickiandAdieViljoen
4 LipidManagement,68
AdieViljoenandAnthonyS.Wierzbicki
5 Arrhythmias,90
AbhayBajpaiandA.JohnCamm
6 Hypotension,135
SurajAlakkassery
7 IschaemicHeartDisease,152
WilbertS.Aronow
8 HeartFailure,172
MichaelW.Rich
9 CardiacSurgery,202
UlrichO.vonOppellandAdamSzafranek
10 CardiacRehabilitation,234
Niccolo` Marchionni,FrancescoFattirolli,FrancescoOrso,MarcoBaccini,Lucio
A.RinaldiandGiulioMasotti
11 AcuteStrokeCareandManagementofCarotidArteryStenosis,261
DavidDoigandMartinM.Brown
12 StrokeRehabilitation,299
LalitKalra
v
vi Contents
13 CommunicationDisordersandDysphagia,329
PamelaM.Enderby
14 PeripheralArterialDisease,345
LeocadioRodr´ıguez-Man˜as,MartaCastroRodr´ıguezandCristinaAlonso
Bouzo´n
15 VenousThromboembolism,366
GordonD.O.Lowe
16 PlanningCardiovascularInvestigationsandManagementofOlder
People,376
JenniferK.Harrison,TerenceJ.QuinnandDavidJ.Stott
Index,395
List of Contributors
AhmedH.Abdelhafiz
RotherhamGeneralHospital,Rotherham,Yorkshire,UK
SurajAlakkassery
SaintLouisUniversityMedicalCenter,StLouis,MO,USA
CristinaAlonsoBouzo´n
HospitalUniversitariodeGetafe,Madrid,Spain
WilbertS.Aronow
NewYorkMedicalCollege,Valhalla,NY,USA
MarcoBaccini
UniversityofFlorenceandAziendaOspedaliero–UniversitariaCareggi,Florence,Italy
AbhayBajpai
StGeorge’sHospital,UniversityofLondon,London,UK
MartinM.Brown
InstituteofNeurology,UniversityCollegeLondon,London,UK
A.JohnCamm
StGeorge’sHospital,UniversityofLondon,London,UK
MartaCastroRodr´ıguez
HospitalUniversitariodeGetafe,Madrid,Spain
DavidDoig
InstituteofNeurology,UniversityCollegeLondon,London,UK
PamelaM.Enderby
UniversityofSheffield,Sheffield,UK
FrancescoFattirolli
UniversityofFlorenceandAziendaOspedaliero–UniversitariaCareggi,Florence,Italy
JenniferK.Harrison
GlasgowRoyalInfirmary,Glasgow,Scotland,UK
LalitKalra
King’sCollege,London,UK
vii
viii ListofContributors
GordonD.O.Lowe
InstituteofCardiovascularandMedicalSciences,UniversityofGlasgow,GlasgowRoyalInfirmary,
Glasgow,Scotland,UK
LeocadioRodr´ıguezMan˜as
HospitalUniversitariodeGetafe,Madrid,Spain
Niccolo` Marchionni
UniversityofFlorenceandAziendaOspedaliero–UniversitariaCareggi,Florence,Italy
GiulioMasotti
UniversityofFlorenceandAziendaOspedaliero–UniversitariaCareggi,Florence,Italy
FrancescoOrso
UniversityofFlorenceandAziendaOspedaliero–UniversitariaCareggi,Florence,Italy
TerenceJ.Quinn
InstituteofCardiovascularandMedicalSciences,UniversityofGlasgow,GlasgowRoyalInfirmary,
Glasgow,Scotland,UK
MichaelW.Rich
WashingtonUniversitySchoolofMedicine,StLouis,MO,USA
LucioA.Rinaldi
UniversityofFlorenceandAziendaOspedaliero–UniversitariaCareggi,Florence,Italy
DavidJ.Stott
InstituteofCardiovascularandMedicalSciences,UniversityofGlasgow,GlasgowRoyalInfirmary,
Glasgow,Scotland,UK
AdamSzafranek
UniversityHospitalofWales,CardiffandValeUniversityHealthBoard,UniversityofCardiff,Wales,
UK
AnthonyS.Wierzbicki
Guy’sandStThomas’Hospitals,London,UK
AdieViljoen
ListerHospital,Stevenage,Hertfordshire,andBedfordshireandHertfordshirePostgraduateMedical
School,Luton,Hertfordshire,UK
UlrichO.vonOppell
UniversityHospitalofWales,CardiffandValeUniversityHealthBoard,UniversityofCardiff,Wales,
UK
Foreword
Thereductionintheage-specificmortalityandmorbidityfromcardiovas-
cular disease in developed countries has been one of the great medical
success stories of the last 50 years. A solid foundation of epidemiology
coupled with improved understanding of the pathophysiology of cardio-
vascular disease in general, and atherosclerosis in particular, has been
achieved. Approaches to the primary and secondary prevention of car-
diovascular disease, as well as medical and interventional procedures for
treatment of symptomatic disease, have been developed and validated by
randomizedcontrolledtrials,givingcardiovascularmedicineanunrivalled
evidencebaseofeffectiveinterventions.Unfortunately,sincemostcardio-
vascular disease is essentially progressive and degenerative, reductions in
mortalityinmiddleagehaveresultedinanincreasingpopulationofolder
individuals with overt or silent cardiovascular disease. Thus the overall
prevalence of individuals with cardiac and cerebrovascular disease is ris-
ing. Although many of the treatment paradigms applicable to younger
patients can be translated to the older patient, the prevalence of comor-
bidities, frailty and cognitive decline require a more holistic approach to
themanagementofcardiovasculardiseaseinelderlypeople.
Thepurposeofthisbookistoprovidethenon-specialistreaderwithan
up-to-datereviewoftheepidemiology,pathophysiologyandmanagement
of cardiovascular disease in older people. Most of the chapters would be
found in a textbook of general medicine, but the impact of physiological
and pathological ageing and the importance of comorbidity and frailty
onclinicalmanagementareemphasizedthroughout.Therelativepaucity
of clinical trial evidence in the over-80s, or in specific groups such as
those with cognitive impairment, nursing home residents or the frail, is
emphasized, and should stimulate further research. The book concludes
withathoughtfuldiscussiononthescope,limitationsandappropriateness
ofaggressiveinvestigationandmanagementinoldersubjects.
StuartM.Cobbe
EmeritusProfessorofMedicalCardiology
UniversityofGlasgow
May2012
ix
Introduction
Prevention and treatment of cardiovascular disease in older people is an
increasing part of primary and secondary care. Heart disease, stroke and
peripheral vascular diseases are increasingly prevalent worldwide, due to
increasing numbers of older persons; the persistence of major risk factors
including tobacco smoking, hypertension and hyperlipidaemia; and the
global epidemic of obesity and diabetes. Optimal management requires
recognition of multiple morbidities in elderly patients, and a holistic
approachtotheirmanagement.
This book is based on the chapters in the Section on Cardiovascular
DiseasesandHealth,andchaptersoncerebrovasculardiseaseintheSection
on Central Nervous System Disorders, from the latest, fifth edition of
Pathy’s Principles and Practice of Geriatric Medicine, edited by Alan Sinclair
and colleagues. We hope that these chapters from this standard textbook
for geriatricians, together with an additional chapter on tailoring the
approach to investigation and management of vascular disease in frail
older subjects, will provide a useful resource to general practitioners and
hospitalcliniciansandtheirteams.
We have performed some further editing to the chapters: principally
someupdatingonrecentevidence,andaddingreferencestorecentclinical
practice guidelines in Europe and North America. Management of car-
diovascular disease is a rapidly changing field, and readers may find the
followingwebsitestobeusefulsupplementstothisbook:
GuidelinesInternationalNetwork(G-I-N):www.g-i-n.net
AmericanHeartAssociation(AHA):www.heart.org
AmericanStrokeAssociation(ASA):www.strokeassociation.org
CanadianHeartandStrokeFoundation:www.heartandstroke.ca
AmericanCollegeofChestPhysicians(ACCP):www.chestnet.org
EuropeanHeartAssociation(EHA):www.escardio.org/guidelines
National Institute for Health and Clinical Excellence (NICE): www
.nice.org.uk
ScottishIntercollegiateGuidelinesNetwork(SIGN):www.sign.ac.uk
AustralianGovernment,NationalHealthandMedicalResearchCouncil:
www.nhmrc.gov.au
xi
xii Introduction
NewZealandGuidelinesGroup:www.nzgg.org.nz
Guidanceonsystemsandprocessesofacutemedicalcareforfrailolder
people is given in the Royal College of Physicians Acute Care Toolkit 3:
http://rcplondon.us1.list-manage.com/track/click?u=bc4bee17da1faeabe
3a951bca&id=33faac6a13&e=012fdadfb6
We welcome feedback on the usefulness of this book. We thank our
colleaguechapterauthors;ProfessorStuartCobbeforhisForeword;Robyn
LyonsandFionaSeymourandtheircolleaguesatWiley-Blackwellforthe
originalsuggestionandfortheirefficiencyinitsproduction;andasalways
ourfamiliesfortheirsupport.
DJSandGDOL,Glasgow
April2012