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Aggressive Therapy Helps Older Heart Patients

Study finds it shouldn't be shunned simply because of age

WEDNESDAY, Feb. 4, 2004 (HealthDayNews) -- Doctors can fail to give patients with emergency cardiac conditions lifesaving treatments simply because they are very old, an Israeli study claims.

A study of such patients shows a quick decision to perform artery-opening angioplasty or bypass surgery can save the lives and improve well-being for many people in their 80s, says a report in the Feb. 4 issue of the Journal of the American College of Cardiology.

The key to success is the doctor's assessment of which patients are likely to benefit from such aggressive treatment, says study author Dr. David A. Halon, a cardiologist at Lady Davis Carmel Medical Center in Haifa.

"The study shows that by selecting suitable elderly patients that are likely to benefit from further investigation and treatment, worthwhile clinical improvement can be obtained even in the very elderly," says Halon, a professor of medicine at the Bruce Rappaport School of Medicine, also in Haifa.

"The actual proportion of patients in whom intervention can be performed with low morbidity and significant benefit does seem to have increased in recent years and may continue to do so, but careful individual patient selection, based on clinical and interventional experience, will continue to be needed in selecting such patients," Halon adds.

Dr. Christopher P. Cannon, an associate professor of medicine at Harvard Medical School and a spokesman for the American College of Cardiology, acknowledges that, "in general, doctors just aren't as aggressive as they should be in treating very old patients."

But "we can't just send everyone" for those treatments, Cannon says. "There has to be clinical judgment, looking at cardiac risk using many of the tools we have. Once you decide a patient's cardiac risk, you can then balance benefits against any safety concerns."

The Israeli study looked at 449 patients -- 251 in their 70s, 198 at least 80 years old -- who came to hospitals with a diagnosis of acute coronary syndrome, a catchall phrase for critical problems including a heart attack to heart failure.

The very old patients were less likely to be selected for angiography, a test that evaluates the condition of blood vessels as a prelude to angioplasty or bypass surgery, the study finds. That selection was based on the clinical judgment of the attending physicians.

A similar percentage of the very older people went on to have angioplasty or bypass surgery. Overall, the two-year survival rate for the 80-year-olds was worse than for the 70-year-olds (67.4 percent vs. 83.5 percent), but the group selected for angiography "had two-year outcomes similar to the younger cohort," the report says.

Indeed, when the older survivors were asked about their well-being, 60 percent of them reported improvement, compared to 46.3 percent of the younger patients.

"I think the bottom line is that there are important differences between elderly patients, and if patients are assessed individually for suitability for further investigation and possible intervention, then benefit may be achieved in a sizable proportion of even very elderly patients," Halon says.

The study addresses a continuing paradox in coronary care, Cannon says.

"The elderly are at higher risk, where our guidelines would say be more aggressive, yet they receive less aggressive care," he says. "In this study, they found that patients treated more aggressively seemed to do better. Thus, this study suggests we need to be more aggressive with our elderly patients."

More information

A description of acute coronary syndrome can be found at the American Heart Association or MedlinePlus.

SOURCES: David A. Halon, M.D., professor, medicine, Bruce Rappaport School of Medicine, Haifa, Israel; Christopher P. Cannon, M.D., professor, medicine, Harvard Medical School, Boston; Feb. 4, 2004, Journal of the American College of Cardiology
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