Cardiovascular Disease in the Elderly PDF

Preface

In 2010, the first of the "baby boomers" will turn 65 years old. This event will herald an explosive growth in the older adult population in the United States, from just over 40 million in 2010 to approximately 72 million by 2030, an increase of 80%a. Concomitantly, the proportion of the populace over age 65 will increase from about 1 in 8 to about 1 in 5. Accompanying this "graying of America" will be a dramatic rise in the number of older persons with clinically manifest-or at risk of developing-cardiovascular disorders, including hypertension, coronary artery disease, valvular heart disease, heart failure, and cardiac rhythm disturbances. Since persons over 65 already account for more than 80% of all deaths attributable to cardiovascular disease, it will become imperative in the years ahead for all clinicians involved in the care of older adults-not just primary care physicians, geriatricians, and cardiologists, but also surgeons, anesthesiologists, other medical subspecialists, and nurse practitioners-to have a basic understanding of the effects of aging on cardiovascular structure and function, as well as of the impact of aging and prevalent comorbid conditions on the clinical presentation, diagnosis, and response to therapy in older adults with cardiovascular disease.

As with prior editions, the primary objective of the present volume is to provide an upto- date and in-depth, yet clinically relevant and "readable," overview of the epidemiology, pathophysiology, evaluation, and treatment of cardiovascular disorders in older adults. All chapters have been thoroughly updated by recognized experts to incorporate the most recent developments in the field. To the extent possible, clinical recommendations are "evidence based," but it is also acknowledged that existing data are often thin to nonexistent in the very elderly (persons 85 years of age or older), and especially in older adults with multiple coexisting conditions and/or frailty. Thus, careful consideration of each patient's unique clinical and psychosocial circumstances, medical and nonmedical needs, and personal preferences is required in designing an individualized management plan. Indeed, it is perhaps in the compassionate management of these challenging patients where the "art of medicine" most clearly flourishes.

The first three editions of Cardiovascular Disease in the Elderly were published by Marcel Dekker in 1994, 1999, and 2004; i.e., at five-year intervals. With the fourth edition, Informa Healthcare has taken over as publisher, and publication has been accelerated by a year, primarily in response to the increasing volume of literature relevant to cardiovascular disease in older adults. It is noteworthy that the number of articles

posted on Medline at the intersection of "cardiovascular disease" and "age greater than 65 years" increased from 1391 for the three-year period 1997-1999 to 1842 for the period 2000–2002, and to 2630 in the interval 2003-2005-a doubling in the number of citations over a nine-year period. In further recognition of the growing importance of the elderly population in cardiovascular medicine, an increasing number of clinical trials focusing on older adults have been undertaken, and practice guidelines are increasingly providing explicit commentary on the diagnosis and management of older adults.

With this edition, Dr. Michael W. Rich joins Drs. Wilbert S. Aronow and Jerome L. Fleg as coeditor. The general format of the text is similar to the previous edition. There are eight sections comprising 32 chapters, all written by recognized authorities in geriatric cardiology. The chapter topics remain the same as those in the third edition, with one exception. Information from the chapter "Pathophysiology of Coronary Artery Disease in the Elderly" has been incorporated into the other chapters on the diagnosis and treatment of this condition, while a new chapter, "Disability and Frailty in Older Patients with Cardiovascular Disease," has been added.

We would like to thank all of the contributors for their outstanding work. We also wish to express our gratitude to Sandra Beberman at Informa Healthcare for her dedication and support in bringing this fourth edition to fruition. Finally, we want to thank you, the reader, for your commitment to providing the best possible care for your older patients with cardiovascular disease. We hope you will find this volume to be a valuable resource as you strive to help your older patients enjoy both longer and fuller lives. We welcome any comments you may have.