Both the article by Dr Krumholz and colleagues1 and the Editorial by Drs Gurwitz and Goldberg2 point out that thrombolytic therapy in older patients with myocardial infarction is not yet routinely used in medical practice. Thus, clinical decisions in this setting often are not evidence based; rather, the decision not to administer thrombolytic therapy is mainly driven by physicians' personal opinions, almost never clearly stated. Appropriate choices of treatment for older patients—and even better outcomes—will probably only be achieved when comprehensive geriatric assessment (CGA) becomes part of routine treatment of cardiac disorders. Indeed, patients with heart disease are those who mainly benefit from CGA.2 In a recent editorial, Parmley has recommended that cardiologists practice geriatric assessment when dealing with "frail" elderly patients.3
The findings by Krumholz et al highlight the necessity to update evaluation methods in geriatric cardiology. In this study,for example, an older patient's confusion was
Bernabei R, Zuccalà G, Carbonin P. Thrombolytic Therapy for Elderly Patients With Myocardial Infarction. JAMA. 1997;278(17):1401. doi:10.1001/jama.1997.03550170031016
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