Archive for February, 2012

Chronic Coronary Disease in Older Adults – You CAN treat angina!

Dr Joseph Tenenbaum, discussed the diagnosis and care of stable Angina in older adults.

Chronic Coronary Disease in Older Adults – You CAN treat angina!

Dr Tenenbaum is Chief of Medicine Service at Allen Hospital/NYP and Professor of Clinical Medicine at Columbia University College of Physicians and Surgeons.

SEE THE COMPLETE PRESENTATION HERE

TAKE THE PRE-TEST HERE

TAKE THE POST-TEST HERE

See the slide set below (in two parts).

Geriatric Cardiology – You CAN treat Angina! Part 1

Geriatric Cardiology – You CAN treat Angina! Part 2

Suggested Reading:

Focused Update of the ACC-AHA 2002 Guidelines for the Management of Patients with Chronic Stable Angina, J Am Coll Cardiol 2007; 50:2264-2274

The Cardiovascular Health, Study J Am Geriatr Soc 52:1639–1647, 2004

Treating to New Targets, N Engl J Med 2005; 352:1425

STS Database for CABG Only outcomes in the elderly, J Am Coll Surg 2003; 197:347-357

COURAGE Trial, N Engl J Med 2007; 356: 1503-16.

TIME Trial, JAMA 2003; 289: 1117

Ranolazine for the Treatment of Angina, CIRCULATION 2006; 113: 2462

Learning Objectives:

–Recognize differences in epidemiology and disease presentation of chronic coronary disease in older adults compared to younger adults.

–Consider issues related to medical management and safe revascularization of chronic CAD in older adults with a focus on:

* Management of multiple comorbidities.
* Role of collaborative care models.
* Risk of polypharmacy and management strategies
* Use of drug eluting versus bare metal stents for revascularization
* Efficacy of standard and emerging therapies for managing angina
* Process of informed consent specific to older adults with CAD
* Risk stratification of older adults with CAD.

–Enumerate at least three unmet needs in the area that are ripe for multicenter collaboration.

Valve Disease in Older Adults

Valve Disease in Older Adults by Dr Allan Schwartz — Dr Schwartz is a Columbia University College of Physicians and Surgeons, Seymour Milstein Professor of Clinical Cardiology and Harold Ames Hatch Professor of Clinical Medicine.

View the entire presentation:

At this link.

See the slideset (in two parts):

March 20-21 – Valve Disease in Older Adults (Part 1)

March 20-21 – Valve Disease in Older Adults (Part 2)

Take the Pre-Test:

Here

Take the Post-Test:

Here

Suggested Reading:

PARTNER Trial Investigators. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010 Oct
21;363(17):1597-607

PARTNER Trial Investigators. Transcatheter versus surgical
aortic-valve replacement in high-risk patients. N Engl J Med. 2011 Jun
9;364(23):2187-98

Learning Objective:

To understand how advanced age impacts the clinical presentation and treatment strategies for elderly patients with Valvular Heart Disease.

Meaningful Benefit at Minimal Risk — The Frailty Phenotype

Thanks go to Dr Linda Fried, Dean of Mailman School of Public Health and Vice-President, Columbia University, for the GNYGCC seminar, Meaningful Benefit at Minimal Risk — The Frailty Phenotype.

This seminar focused on the frailty syndrome which Dr. Fried and colleagues operationalized in the Cardiovascular Health Study as a useful means of evaluating older adults. She articulated the syndrome of frailty and the Unmet Needs of Frailty assessment and consideration in Cardiovascular care.

View the entire presentation, Meaningful Benefit at Minimal Risk — The Frailty Phenotype at this link.

The complete slide set is available here.

Take the Pre-Test.

Take the Post-Test.

Suggested Reading:

Frail patients are at increased risk for mortality and prolonged institutional care after cardiac surgery. Circulation

Frailty as a predictor of surgical outcomes in older patients

Cardiovascular Health Study Research Group. Associations of subclinical cardiovascular disease with frailty

Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype

Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance

Learning Objectives:

1) Define the frailty phenotype
2) Distinguish frailty from disability and co-morbidity
3) Enumerate the methods available to define the frailty phenotype, the need for multi-dimensional assessment and whether the phenotype should include cognitive as well as physical assessments.
4) Enumerate how frailty assessment can be used to predict outcomes of older adults undergoing invasive procedures.
5) Delineate how assessment of frailty might be employed to manage risk for older adults with cardiovascular disease.
Recognize hazards of hospitalization and surgery for frail older adults and formulate appropriate prevention and treatment plans.
6) Enumerate at least three unmet needs in the area that are ripe for multicenter collaboration.