THE EUROPEAN CARDIOLOGIST - JOURNAL BY FAX

concerning cardiovascular mortality.3 Our own data, based on 3045 consecutive adult intensive care patients, demonstrate that CHD is associated with increased complications in patients undergoing medical intensive care, particularly in the elderly: multiorgan failure (MOF) was seen in 75% of critically ill elderly patients (>75) with clinically manifest CHD, whereas only 68% of the elderly patients without CHD showed MOF. Still more pronounced was the rate of mortality in the elderly: 38% of those with CHD died during their stay in the intensive care unit, whereas elderly patients without CHD only showed an 18% mortality in the critical care unit. The data suggest that the assessment of clinical manifestations of CHD is an important adjunct in the context of admission politics (unpublished recent data). Furthermore, CHD in elderly patients remains underdiagnosed, while they are more likely to have comorbid conditions, atypical presentations, and unfavorable outcomes than their younger counterparts. Some of these differences are undoubtedly related to the structural and functional changes in the cardiovascular system associated with aging.4 Published data also suggest that standard pharmacological, thrombolytic, and interventional revascularization techniques play an important role in the outcome of critically ill patients with CHD, but have been underused, creating a large treatment gap between recommended therapeutic strategies and strategies that are actually applied.5 In summary, there is little information on the impact of CHD in critically ill elderly patients. The fact that the presence of CHD may double mortality should be taken into account in admission policies, and, at the same time, if admitted, adequate management of CHD should be guaranteed. ο P. KAUFMANN, K-H. SMOLLE, and R. GASSER - Graz, Austria (Guest Authors)