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 subdivided into subtypes in accordance with the characteristics of its superficial molecules (designated by the abbreviations HA and NA). There are currently 2 subtypes of influenza A in circulation among humans: H1N1 and H3N2. The mortality associated with this virus may be elevated in more elderly and very young individuals, as well as in those with respiratory, cardiovascular, or renal pathologies, or diabetes, for example. The severity of the illness may be due to the virus itself or, more frequently, overlapping bacterial infections that follow influenza. There are 2 types of influenza vaccine, trivalent (3V) and quadrivalent (4V). The 3V protects against the H1N1 and H3N2 strains (both influenza A) and against a 1 type of the influenza B virus. The 4V protects against the forenamed strains and, additionally, against a second influenza B virus. Provided that it is available, the 4V influenza vaccine is preferable to the 3V, as it provides greater protection against circulating strains. If it is not possible to use the 4V vaccine, the 3V vaccine should be used. The vaccine offered by the public system is the 3V. Contraindications include known systemic hypersensitivity to any medication or substance, including neomycin, formaldehyde, triton-X-100 (octoxinol 9), eggs, or chicken protein, either following the administration of this vaccine or a vaccine containing the same composition. People with acute febrile diseases should not, normally, be vaccinated until these symptoms have disappeared. Pneumococcal vaccine [indicated for all elderly individuals] – This vaccine protects against invasive infections (sepsis, meningitis, pneumonia, and bacteremia) and acute otitis media (AOM), caused by some serotypes of Streptococcus pneumoniae . It starts with a dose of VPC13, followed by a dose of VPP23 6 to 12 months later, and a second dose of VPP23, 5 years after the first. For those who have already received VPP23, an interval of 1 year is recommended for the application of VPC13. A second dose of VPP23 should be given 5 years after the first, maintaining an interval of 6 to 12 months after the dose of VPC13. For those who have already received 2 doses of VPP23, a dose of VPC13 is recommended at a minimal interval of 1 year after the latest dose of VPP23. If the second dose of VPP23 was applied before age 65, a third dose is recommended after this age, with a minimum interval of 5 years after the latest dose. This vaccine is available through the public system for risk groups (COPD, diabetes, etc.) Diphtheria, tetanus, and acellular pertussis (DTaP)/ diphtheria and tetanus (DT) [indicated for all elderly patients] – This vaccine protects against diphtheria, tetanus, and acellular pertussis (DTaP) or diphtheria and tetanus (DT). A DTaP booster is necessary, regardless of previous DT or tetanus interval. For elderly patients who intend to travel to countries where polio is endemic, the combined DTaP inactivated poliovirus vaccine (DTaP-IPV) is recommended. The combined DTaP-IPV vaccine may substitute the DTaP. When the basic vaccination schedule for tetanus is complete, a DTaP booster is recommended every 10 years. When the basic vaccination scheme for tetanus is incomplete, a DTaP dose is recommended at any moment, completing basic vaccination with 1 or 2 doses of adult DT vaccine, in a manner that totals 3 doses of tetanus vaccine. This vaccine is recommended, even in individuals who have already had pertussis, given that protection provided by the infection is not permanent. It is possible to consider anticipating a DTaP booster, containing the pertussis component, to 5 years after the latest dose in elderly individuals who are in contact with breastfeeding infants. The DT is available through the public system. Herpes zoster [indicated for all elderly patients] – This vaccine is recommended even in patients who have already had herpes zoster. In these cases, a minimum interval of 1 year is necessary between the acute phase and the vaccine application. In cases of patients with a history of ophthalmic herpes zoster, there are still not enough data to indicate or contraindicate the vaccine. Regarding use in immunocompromised patients, the vaccine should not be used in individuals with primary or acquired immunodeficiency states or those undergoing drug therapy at doses considered immunosuppressive. This vaccine is not available through the public system. 1.14.2. Other Vaccines (Non-Routine) Hepatitis A, B, or A+B – Hepatitis A: 2 doses, in 0 and 6 month schedule. Hepatitis B: 3 doses, 0, 1, and 6 month schedule. Hepatitis A and B: 3 doses, 0, 1, and 6 month schedule. For hepatitis A, in the over 60 population, susceptible individuals are not commonly found. Vaccination is, thus, not a priority in this group. Serology may be requested in order to determine whether or not to vaccinate. In patients who have contact with hepatitis A or during an outbreak of the disease, vaccination should be considered. Regarding hepatitis A, B, and A+B, the combined hepatitis A and B vaccine is an option, and it may substitute isolated vaccination for hepatitis A and B. Yellow fever – The vaccine is necessary in residents of risk areas and in those who intend to travel to these areas, at least 10 days before travel. If the risk persists, 10 years later, a second dose is necessary. This vaccine is contraindicated in immunocompromised individuals; however, when the risks of acquiring the disease outweigh the potential risks associated with vaccination, the physician should evaluate its use. There are reports of a higher risk of serious adverse events in patients over 60 years of age; therefore, if it is the primary vaccination, it is necessary to assess the risk-benefit ratio. Measles, mumps, and rubella – Individuals are considered protected when they have, at some point in their lives, over 1 year of age, received 2 doses of the measles, mumps, and rubella vaccine with a minimum interval of 1 month between them. The vaccine is indicated in increased risk situations, given that the majority of people in this age group are not susceptible to these diseases. In the over 60 population, individuals susceptible to measles, mumps, and rubella are not commonly found. In this group, vaccination is thus, not routine. Nonetheless, according to medical criteria (during outbreaks, before travel, et al.), it may be recommended. It is contraindicated in immunocompromised individuals. 1.15. Palliative Care Palliative care (PC), which was initially focused on oncology, has been incorporated into diverse practice areas, one of which is cardiology, with discussions on PC in the area of 665