IMR Press / RCM / Volume 23 / Issue 2 / DOI: 10.31083/j.rcm2302055
Open Access Review
Ethical considerations in elderly patients with acute coronary syndrome
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1 Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Asturias, Spain
2 Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, 46010 Valencia, Spain
3 Cardiology Department, Hospital Universitario La Princesa, 28006 Madrid, Spain
4 Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, 08907 Barcelona, Spain
5 Cardiology Department, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), 28007 Madrid, Spain
6 School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
7 School of Biomedical Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
*Correspondence: mmselles@secardiologia.es (Manuel Martínez-Sellés)
Academic Editor: Peter A. McCullough
Rev. Cardiovasc. Med. 2022, 23(2), 55; https://doi.org/10.31083/j.rcm2302055
Submitted: 1 November 2021 | Revised: 10 December 2021 | Accepted: 17 December 2021 | Published: 11 February 2022
(This article belongs to the Special Issue Acute Coronary Syndromes in the Octogenarians)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Acute coronary syndrome (ACS) is one of the main causes of mortality and morbidity in the elderly. The prevalence of ACS increases with age and patients with advanced age have some co-morbidities that require an individualized approach, which includes a comprehensive geriatric assessment. Ageism is a matter of great concern. In this scenario, some ethical conflicts may arise which should be anticipated, considered, and solved. Clinicians will need to prioritize and allocate resources, to avoid futility/proportionality, which is not always easy to assess in these patients. This review aims to summarize the evidence regarding ethical conflicts that may arise in the management of patients with ACS and advanced age. We will discuss how to choose the best option (which frequently is not the only one) with the lowest risk for harm, considering and respecting the patients’ decision. The four basic principles of bioethics (beneficence, non-maleficence, autonomy, and justice) are thoroughly reviewed, and discussed, regarding their role in the decision making process.

Keywords
Ethics
Acute coronary syndrome
Ageism
Prioritization
Futility
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