ABC | Volume 112, Nº5, May 2019

Updated Updated Geriatric Cardiology Guidelines of the Brazilian Society of Cardiology – 2019 Arq Bras Cardiol. 2019; 112(5):649-705 Content 1. General Aspects of Old Age, Risk Factors, and Prevention ......654 1.1. Demographic and Epidemiological Aspects ......................................654 1.2. Interpretation of Frailty .....................................................................655 1.3. Particularities in the Evaluation of Elderly Patients ...........................656 1.4. Particularities in the Treatment of Elderly Patients ...........................656 1.5. Diabetes Mellitus in Elderly Patients .................................................657 1.6. Tobacco Use ......................................................................................657 1.7. Obesity ..............................................................................................658 1.8. Sedentarism .....................................................................................659 1.9. Dyslipidemia in Elderly Patients ........................................................660 1.10. Depression and Cardiovascular Disease .........................................660 1.10.1. Treating Depression and Anxiety in Patients with Cardiovascular Disease ...................................................................................................661 1.11. Other Cardiovascular Risk Factors ..................................................661 1.11.1. Hyperuricemia ............................................................................661 1.11.2. C-reactive Protein .......................................................................661 1.11.3. Vitamin D ....................................................................................662 1.11.4. Genetic Factors ...........................................................................662 1.11.5. Coronary Calcium Score .............................................................662 1.11.6. Investigating Subclinical Atherosclerosis ....................................662 1.11.6.1. Ankle-Brachial Index ................................................................662 1.12. Aorta and Carotid Artery Disease ....................................................662 1.12.1. Thoracic Aortic Aneurysm ..........................................................662 1.12.2. Abdominal Aortic Aneurysm .......................................................663 1.12.2.1. Carotid Arteries ........................................................................663 1.12.3. The Original and 10-Year CREST Studies ....................................663 1.12.4. Precautions and Recommendations ...........................................664 1.13. Evaluation of Surgical Risk in Elderly Patients ................................664 1.14. Vaccination in Elderly Patients ........................................................664 1.14.1. Brazilian Immunization Society (SBIm) Recommendations – 2015/2016 ...............................................................................................664 1.14.2. Other Vaccines (Non-Routine) ....................................................665 1.15. Palliative Care ................................................................................665 2. Chronic Coronary Disease ..............................................................666 2.1. Peculiarities of Diagnosing Chronic Coronary Artery Disease in Elderly Patients ...................................................................................................666 2.2. Peculiarities of Treating Chronic Coronary Artery Disease in Elderly Patients ...................................................................................................667 2.3. General Recommendations – Chronic Coronary Artery Disease in Elderly Patients ........................................................................................668 3. Acute Coronary Disease .................................................................669 3.1. Diagnostic Peculiarities ....................................................................669 3.2. Treatment Peculiarities .....................................................................669 3.3. General Recommendations – Acute Coronary Syndrome in Elderly Patients ...................................................................................................670 4. Heart Failure ....................................................................................670 4.1. Diagnostic Peculiarities of Heart Failure in Elderly Patients .................670 4.2. Treatment Peculiarities of Heart Failure in Elderly Patients .................672 4.3. General Recommendations for Elderly Heart Failure Patients .............672 5. Arterial Hypertension in the Elderly ..............................................675 5.1. Diagnostic Peculiarities ....................................................................675 5.1.1. Peculiarities in Measuring Blood Pressure ...................................675 5.1.2. Peculiarities of Clinical Laboratory Investigation .........................676 5.2. Treatment Peculiarities .....................................................................676 5.2.1. Therapeutic Goals for Elderly Patients .........................................676 5.2.2. Medical and Non-Medical Treatments .........................................677 6. Valvulopathies ..................................................................................677 6.1. Mitral Stenosis ..................................................................................677 6.1.1. Diagnostic Peculiarities ................................................................677 6.1.2. Treatment Peculiarities .................................................................678 6.2. Mitral Regurgitation ..........................................................................679 6.2.1. Diagnostic Peculiarities ................................................................679 6.2.2. Treatment Peculiarities .................................................................680 6.3. Aortic Stenosis ..................................................................................681 6.3.1. Diagnostic Peculiarities ................................................................681 6.3.2. Treatment Peculiarities .................................................................681 6.4. Aortic Regurgitation ..........................................................................682 6.4.1. Diagnostic Peculiarities ................................................................682 6.4.2. Treatment Peculiarities .................................................................683 6.5. Infective Endocarditis ........................................................................683 6.5.1. Diagnostic Peculiarities ................................................................683 6.5.2. Treatment Peculiarities .................................................................684 7. Cardiac Arrhythmias ........................................................................685 7.1. Syncope and Bradyarrhythmias .........................................................685 7.1.1. Syncope and Its Differential Diagnoses in Elderly Patients .........685 7.1.1.1. Stratifying Risk of Death .............................................................686 7.1.1.2. General Recommendations ........................................................686 7.1.2. Diagnostic Peculiarities of Bradyarrhythmias ...............................686 7.1.3. Treatment Peculiarities .................................................................688 7.2. Tachyarrhythmias in Elderly Patients .................................................688 7.2.1. Diagnostic Peculiarities ................................................................688 7.2.2. Treatment Peculiarities .................................................................690 7.3. Atrial Fibrillation ................................................................................690 7.3.1. Diagnostic Peculiarities ................................................................690 7.3.2. Treatment Peculiarities .................................................................692 7.3.2.1. Heart Rate Control .....................................................................692 7.3.3. Oral Anticoagulants in Elderly Atrial Fibrillation Patients ............692 7.3.3.1. General Recommendations ........................................................693 References ............................................................................................694 1. General Aspects of Old Age, Risk Factors, and Prevention 1.1. Demographic and Epidemiological Aspects Since the second half of the 20 th Century, survival has been democratized in numerous countries around the world. This means that more people are reaching more advanced ages. In Brazil, in 1980, of every 100 female live births, 30 could be expected to reach their 80 th birthday; in 2013, this number increased to 55. The average lifespan of the Brazilian population, consequently, increased nearly 12 years during this period. One of the factors responsible for this phenomenon was the decrease in advanced age mortality, which was the result of the control of theretofore lethal diseases. However, many of these diseases that ceased to be lethal are still not curable. As a consequence, the aged population, which continues aging and becomes more heterogeneous, has grown. This heterogeneity is due to differentiated gender, age, and epidemiological profile, among other factors. For example, of the approximately 26 million people age 60 or over, 56.4% were women, and 13.8% were age 80 or over. It is worth highlighting that not only is the aging process expected to increase, but the aged populated itself is also expected to age further. Or be it, the population age 80 or over is the one that grows the most, given the reduced mortality in this age group 1 (Table 1). It is known that advanced age leads to the need to live with chronic, incapacitating diseases, which may compromise individual autonomy. In 2013, only 22.3% of elderly Brazilians declared that they had no chronic diseases. Approximately half, 48.6%, declared that they had 1 or 2 diseases, and 29.1% declared 3 or more. Women have a 654