© Continuing Medical Implementation ® …...bridging the care gap Geriovascular Prevention Optimizing Prevention of Cardiovascular Disease in the Elderly Patient

© Continuing Medical Implementation ® …...bridging the care gap Primary Prevention Dietary modification Weight loss Physical activity Smoking cessation Keep the well elderly well Prevent Frailty

© Continuing Medical Implementation ® …...bridging the care gap Secondary Prevention Prevent those with disease from getting worse Improve symptoms Improve quality of life Reduce hospitalization and morbidity Reduce mortality

© Continuing Medical Implementation ® …...bridging the care gap Cardiovascular Risk Reduction- 2  Prevention Coronary Artery Disease Cerebrovascular Disease –TIA –CVA –Carotid Bruit PVD –Symptomatic or asymptomatic AAA Diabetes It’s All the Same Disease

© Continuing Medical Implementation ® …...bridging the care gap Cardiovascular Risk Reduction Cocktail for 2  Prevention Same Disease/Same Rx: –ASA –Lipid Targets TC  4.5, TG  1.7, HDL  1.2, LDL  2.5 TC/HDL  4 –ACE inhibitor HOPE Trial Ramipril 2.5  10 mg –Beta-blocker for post- MI, HPT or CAD

© Continuing Medical Implementation ® …...bridging the care gap Potential Cumulative Impact of 4 Simple Secondary Prevention Treatments RRREvent rate None8% ASA25%6%  -Blockers 25%4.5% Lipid lowering30%3.0% ACE-inhibitors25%2.3% CUMULATIVE BENEFITS ARE LIKELY TO BE IN EXCESS OF 75% RRR Yusuf, S. Two decades of progress in preventing vascular disease. Lancet 2002; 360: 2-3.

© Continuing Medical Implementation ® …...bridging the care gap In which aspects of cardiovascular disease in the elderly can we have the greatest impact? Stroke prevention –Hypertension –Anticoagulation in atrial fibrillation CAD –Secondary prevention –Medical management for symptoms –Appropriate revascularization CHF –Patient education –Admission and readmission prevention –Medical management for prognosis and symptoms