TUESDAY, March 4, 2003 (HealthDayNews) -- If you're elderly and suffering from angina, what's the best treatment?
Should you stick with medications, such as aspirin, beta blockers, ace inhibitors and nitrates?
Or should you look to an invasive procedure, such as coronary bypass surgery, for relief?
A new study by researchers in Switzerland found both strategies significantly improve quality of life and help prevent further heart problems, including fatal heart attacks.
However, both strategies have drawbacks and neither is clearly better than the other for treating angina, a recurring pain or discomfort in the chest that occurs when a part of your heart isn't getting enough blood.
"After one year, quality of life outcome and survival will be similar," the authors write.
The study appears in the March 5 issue of the Journal of the American Medical Association.
Previous research has shown younger angina patients do well when treated with an invasive procedure, according to the study. Invasive procedures include bypass surgery, in which a blood vessel is grafted onto a blocked artery to bypass the diseased section so blood can get to the heart muscle. Another procedure is called percutaneous coronary intervention, in which the blocked area is opened with a balloon or stent.
However, few studies have looked specifically at angina patients aged 75 and older, the authors write.
Doctors tend to avoid invasive procedures in the elderly because of fears that their advanced age could put them at higher risk of death, explains Dr. Stephen Siegel, a cardiologist at New York University Medical Center.
The Swiss researchers divided 282 angina patients, aged 75 to 91, into two groups: one group was treated with medications and the other had an invasive procedure.
The patients in the study had "class 2" or worse angina. Angina symptoms are rated on a scale of one to four, with four being the most severe, explains Dr. John Reilly, an interventional cardiologist at the Ochsner Clinic Foundation in New Orleans. Class 2 angina symptoms include a dull ache in the chest during physical exertion. People with class 4 angina have chest pain even during rest.
Participants were also asked to fill out a questionnaire about their quality of life, including the severity of their angina symptoms and whether the condition affected their ability to work or take part in social and family activities.
The study found that both those treated by medications alone and those who underwent an invasive procedure had an improved quality of life one year later.
However, each strategy had shortcomings.
After six months, the group that had the invasive procedure had a slightly higher death rate, about 8.5 percent compared to 4 percent for the group on medications. At one year, however, the death rate was nearly identical.
Members of the medication-only group had their own problems, including an increased likelihood that they'd be hospitalized for recurring angina symptoms.
Between six months and one year, about 49 percent of patients treated with medications alone had a "major adverse cardiac event," including death, nonfatal heart attack or hospitalization for angina symptoms, compared to only 19 percent of those who underwent an invasive procedure.
Most of those "cardiac events" in the medication-only group were due to people going into the hospital for an invasive procedure.
About 46 percent of patients treated with medications only eventually had an invasive treatment for angina, while only 10 percent of those who were treated with an invasive procedure needed an additional invasive treatment.
Cardiologists who treat angina are generally divided into two camps: those who favor "aggressive" invasive treatments, and those who favor a more conservative, "wait-and-see" approach.
Siegel, who describes himself as on the conservative side, says the Swiss study provides new evidence that older patients can be treated safely and successfully with invasive procedures.
"The most important thing I can distill out of this is, 'Gee, these people did damn good with surgery,'" he says. "This study is helpful in that it will give me some information that I can give to patients to reassure them that if they end up in invasive therapy, they are likely to do well."
Reilly, an expert in invasive angina treatments, says it's important to remember the two strategies aren't mutually exclusive. Angina patients treated with an invasive procedure should also be prescribed medicines to keep their angina at bay.
Both doctors say the bottom line is that each patient has to be evaluated individually. A patient's age, medical history and angina severity all have to be taken into consideration.
"Nothing replaces common sense and individualized treatment for each patient," Siegel says.
More information
To learn more about angina, check with the National Heart, Lung, and Blood Institute or the American Heart Association.
