Management of the older patient after myocardial infarction

After an acute myocardial infarction (AMI), elderly patients should have aggressive treatment of all modifiable coronary risk factors, including smoking cessation, treatment of hypertension, reduction in low-density lipoprotein (LDL) cholesterol, improvement in glycemic control, and weight loss when appropriate. Regular physical activity, beginning with referral to a structured cardiac rehabilitation program, is highly recommended. The appropriate role of aspirin, thienopyridines, anticoagulants, ß-blockers, angiotensin-converting enzyme (ACE) inhibitors, aldosterone antagonists, sodium-glucose cotransporter 2 (SGLT2) inhibitors, and hormone replacement therapy in secondary prevention is discussed. Annual influenza vaccination should be offered. Consideration should be given to the use of implantable cardioverter-defibrillator (ICD) therapy and revascularization in those with guideline-directed indications. Among elderly post-MI patients with significant comorbidities and/or frailty, a focus on patient-centered outcomes other than survival alone may be most appropriate.