Kardiologie up2date 2019; 15(02): 135-154
DOI: 10.1055/a-0849-8957
Spezialthemen
Georg Thieme Verlag KG Stuttgart · New York

Alterskardiologie

Was in der Kardiologie tätige Ärztinnen und Ärzte über die Behandlung älterer Menschen wissen sollten
Markus W. Ferrari
Further Information

Publication History

Publication Date:
11 June 2019 (online)

Ältere Menschen werden häufig jüngeren Menschen gleichgestellt ohne Berücksichtigung der altersassoziierten Veränderungen in Metabolismus und Ansprechen auf bestimmte Therapien. Gerade Dosisfindungsstudien werden oft unter Ausschluss geriatrischer Patienten durchgeführt, weshalb Dosierungen in der Praxis nicht unreflektiert übernommen werden können. Dieser Beitrag diskutiert die „kardiologische Blickweise“ auf Diagnostik und Therapie älterer Patienten.

Kernaussagen
  • Die pharmakologische Primärprävention hat aufgrund fehlender Evidenz in der Alterskardiologie keinen Stellenwert.

  • Da die interindividuellen Unterschiede bezüglich des Ansprechens auf Pharmaka als auch das Nutzen-Risiko-Verhältnis von chirurgischen Eingriffen mit höherem Alter zunehmend größer werden, setzt die Therapie des älteren Menschen eine stärkere Individualisierung und Anpassung an die Komorbiditäten, die persönliche Erwartungshaltung und auch die Prognose voraus.

  • Neue Entwicklungen wie die TAVI-Prozedur zur Behandlung der symptomatischen AS oder das Clipping bei Mitralklappeninsuffizienz tragen dem Wunsch der Patienten nach minimalinvasiven und schonenden Therapien Rechnung.

  • Die Indikation für diese relativ kostenintensiven Verfahren muss bei sehr hochbetagten und teils multimorbiden Patienten mit Augenmaß auf die individuelle Situation, das biologische Alter und den Wunsch des Patienten abgestimmt werden.

  • Pharmakotherapeutisch gesehen sollte bei sehr alten Menschen eine Dosierung auf niedrigst möglicher Stufe das Ziel sein, um so mögliche Nebenwirkungen und Arzneimittelinteraktionen zu minimieren.

  • Das Absetzen einer Medikation (sog. Deprescribing) stellt eine Herausforderung an Kardiologen dar und ist aktuell Gegenstand kontroverser Diskussionen [81], denn gerade bei hochbetagten Menschen steht die Lebensqualität deutlich vor einer Verbesserung der Langzeitprognose.

  • Die Alterskardiologie sollte den Anspruch erheben, dies immer individuell bei der Indikationsstellung zu potenziell belastenden oder risikobehafteten Eingriffen und der Entscheidung für oder gegen diagnostische und therapeutische Maßnahmen mit dem Patienten zu klären.

 
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