| Valuation |
Comorbidity, frailty, dependency, cognitive impairment.Robust, co-morbid, frail patient. |
| Frailty |
Frail Scale. |
| Comorbidity |
Assessment: cognitive impairment, depressive syndromes, chronic kidney disease, chronic obstructive pulmonary disease, neoplastic diseases. Adjustment of medication based on renal function.STOPP/START pharmacological treatment criteria.Treatment adherence. |
| Dyslipidaemia |
Control targets at very high risk > 55 mg/dL and at high risk < 70 mg/dL (and 50 % reduction).Statins treatment of choice. Monitor side effects.Safety ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitors. |
| Hypertension |
In frail patients or those over 80 years of age, start treatment when blood pressure > 160/90 mmHg. Preferably initiate treatment in monotherapy or combination at low doses.Monitor postural hypotension and renal function.Angiotensin converting enzyme inhibitors as treatment of choice. |
| Diabetes |
Hb1a control targets ≤ 7% or < 8% in patients with long-standing diabetes.Monitor for hypoglycaemia or hyperglycaemia.Metformin, sodium-glucose cotransporter-2 inhibitors and agonists of glucagon-like peptide-1 as treatment of choice.Avoid complex insulin regimens, especially in frail patients. |
| Other |
Address nutrition: obesity, malnutrition, sarcopenia.Tobacco: quit smoking with the possibility of using varenicline.Total drug withdrawal (non-alcohol). Influenza and pneumococcal vaccination. |
| Antithrombotic therapy |
Dual antiplatelet therapy up to 12 months after acute coronary syndromes.Haemorrhagic and ischaemic risk assessment for dual antiplatelet therapy prolongation.Treatment of choice acetylsalicylic acid + clopidogrel/ticagrelor. |
| Pharmacological adherence |
Out of choice, drug combinations and polypills. |
| Cardiac Rehabilitation |
Demonstrated benefit in this population.Individually adapted physical exercise to improve physical condition and prevent frailty. Avoid sudden changes in posture.Assessment: nutritional, social and psychological status. |
| Telemedicine |
Benefits in adherence and secondary prevention programmes.Hybrid programmes (supervised and remote).Video calls, phones, app.Web platforms (aularc.es). |
