Cardiologists have long wondered if they should treat older patients as aggressively as they do younger ones. A new study shows that for at least one segment of the 80-and-over demographic, they should consider it.
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In a study that was presented at the American College of Cardiology meeting in March, doctors from Norway reported that patients with certain heart problems who are healthy enough to undergo a procedure to restore blood flow to their heart (stenting) do better having the procedure than just being treated with medication.
“Age is a moving target. Some 80 year olds are healthier than others and we should not make treatment decisions based on age alone. Many people are still enjoying life over 80 and want and deserve the best possible health outcomes we can give them,” says Cleveland Clinic cardiologist Samir Kapadia, MD, commenting on the study.
This study looked at 457 patients who were age 80 and up and have unstable angina (chest pain that happens suddenly and that usually means the heart is not getting enough blood flow or oxygen; it can lead to a heart attack) or Non-ST segment elevation myocardial infarction (NSTEMI) (a type of heart attack). Patients were assigned randomly to receive either medication or stenting.
The study looked at how many patients went on to have a heart attack, need to have another heart procedure performed urgently, had a stroke or died in the following year and a half, and produced an average score for any of these things to happen.
It found that 41 percent of the patients who received the more aggressive treatment had any of these problems in this time frame, compared to 61 percent of those treated with medication only.
Specifically, heart attacks occurred in 17 percent of the aggressively treated group and 30 percent of the other group. Only 2 percent in the aggressive group needed an urgent heart procedure to restore blood flow, compared to 11 percent in the other group.
“These results show there is a considerable difference – 35 percent of patients benefitted from the procedure. That is much higher than we would have expected and it shows that older adults can achieve good outcomes,” Dr. Kapadia says.
Why treat older patients differently?
Older patients are often treated more cautiously than younger ones because they have other health problems that complicate their overall outlook. However, Dr. Kapadia stresses that age is only one predictor of outcomes.
“If you look at all the information that we have today about heart problems, it is very clear that restoring blood flow helps patients, no question about it,” Dr. Kapadia says. “The question being asked here was whether our oldest patients see the same results, and clearly they do.”
Impact on practice patterns
Dr. Kapadia says that while the study results are interesting, they will not likely have a major impact on U.S. healthcare because physicians here are already likely to do more for patients, rather than less.
“This study would have changed our practice patterns a lot if the findings went the other way,” he says. “Our current practice is similar to what they found to be best, that if patients are able to withstand having a procedure to restore blood flow to their heart, we should do it.”
Of course, he adds, deciding who is healthy enough to undergo a procedure often comes down to physician judgment. “This is not something a computer can decide for us,” he says. “We have to talk to the patient and the family to discuss their expectations and their personal risk factors before we make any decisions.”