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Management of acute coronary syndrome in special subgroups: female, older, diabetic and Indigenous patients

While guidelines for the management of acute coronary syndrome (ACS) for the average patient are well defined, their application to special groups is less clear. Some groups have been underrepresented or formally excluded from the clinical trials that constitute the evidence base that guides therapy, and some have special needs that have not been studied in clinical trials. As a result, these subgroups present clinical challenges for which there is weaker evidence to define appropriate management.

This article will assess the special needs of women, older people, patients with diabetes, and Aboriginal and Torres Strait Islander Australians.

Women

Cardiovascular disease remains the leading cause of death in women, and far exceeds deaths from cancer at all ages. Despite the popular perception that heart attack is far more common in men than women, this is true only in younger age groups. Across the full spectrum of age, women account for a large proportion of patients with ACS, comprising up to 45% of patients in some series1 and 40% in a comprehensive snapshot of admissions to coronary care units in Australia and New Zealand in 2012.2

There is considerable evidence that the pattern of coronary disease and ACS is different in men and women.3,4 Women tend…

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