Keele Research Repository

The world's population is ageing and patients with acute coronary syndromes (ACS) are presenting later in life such that a third or more are now aged ≥70.1 ACS mortality rates are higher in older patients,1 and absolute benefits of treatment are, therefore, potentially greater if the balance against harms remains favourable. Randomized trials of both invasive and pharmaceutical ACS treatments have confirmed that efficacy extends to the oldest patients,2,3 yet observational studies continue to show that they are less likely than their younger counterparts to receive these evidence-based therapies.4 Potential reasons for this include the supervision of their care by non-specialists, multiple co-morbidities that limit treatment options and increased complications from treatment that occur more commonly in older patients. Whether the risk-treatment paradox that characterizes the care of older patients with ACS is truly paradoxical or whether it is a reflection of appropriate management decisions is an important question that has not hitherto been answered.