The Living Guidelines: UA/NSTEMI Recommendations for UA/NSTEMI in Elderly Suggest Revisions to the CLASS I Guidelines

Any recommendations found on these pages are for education use only. WikiDoc is not a substitute for a licensed healthcare provider. Please see the disclaimers page for important information regarding limitations of the information found here. In suggesting edits to the guidelines, WikiDoc suggests that the following classification scheme be used. Read more about the classification scheme used by the ACC / AHA Guidelines Committee here.

Instructions on How to Edit the Guidelines:
 * Log in
 * Click on "Edit"
 * Type in changes to guidelines
 * Click "Save page" at the bottom of the page

Class I Guidelines

 * 1) Older patients with UA / NSTEMI should be evaluated for appropriate acute and long term therapeutic interventions in a similar manner as younger patients with UA / NSTEMI. (Level of Evidence: A)
 * 2) Decisions on management of older patients with UA / NSTEMI should not be based solely on chronologic age but should be patient centered, with consideration given to general health, functional and cognitive status, comorbidities, life expectancy, and patient preferences and goals. (Level of Evidence: B)
 * 3) Attention should be given to appropriate dosing (i.e., adjusted by weight and estimated creatinine clearance) of pharmacological agents in older patients with UA / NSTEMI, because they often have altered pharmacokinetics (due to reduced muscle mass, renal and/or hepatic dysfunction, and reduced volume of distribution) and pharmacodynamics (increased risks of hypotension and bleeding). (Level of Evidence: B)
 * 4) Older UA / NSTEMI patients face increased early procedural risks with  revascularization relative to younger patients, yet the overall benefits from invasive strategies are equal to or perhaps greater in older adults and are recommended. (Level of Evidence: B)
 * 5) Consideration should be given to patient and family preferences, quality of life issues, end of life preferences, and sociocultural differences in older patients with UA / NSTEMI. (Level of Evidence: C)