Aggressive Treatment Saves Lives of Older Heart Patients

Procedures such as angioplasty and stenting aren't too taxing, study finds

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By
HealthDay Reporter

TUESDAY, Aug. 3, 2004 (HealthDayNews) -- Quick use of artery-opening procedures such as angioplasty and stenting in emergency situations could halve the number of deaths or second heart attacks in older people.

That confident claim comes in a report in the Aug. 3 issue of the Annals of Internal Medicine.

The study, which included more than 2,200 patients treated in 169 hospitals in nine countries, found no significant differences in results for younger patients, those aged 65 and under, who had conservative treatment -- watchful waiting and drug therapy -- compared to those who got more aggressive therapy.

But it was a very different story for patients aged 75 and older, said study author Dr. Richard G. Bach, an associate professor of medicine at the Washington University School of Medicine in St. Louis.

"For death or recurrent myocardial infarction, there was over a 50 percent reduction," Bach said.

Only 10.8 percent of the patients over 75 who had aggressive treatment died or had a second heart attack, compared to 21.6 percent of those who received conservative treatment, Bach noted.

"A 10 percent absolute percentage reduction is very remarkable," he said. "For every 1,000 patients, 100 events were prevented."

Doctors have hesitated to use aggressive treatment with older heart patients because they feared it would lead to major bleeding that could cause serious damage. In the study, the incidence of major bleeding was higher among patients who got aggressive treatment -- 16.6 percent, compared to 6.5 percent for those who got watchful waiting. But the problems caused by that bleeding were outweighed by the benefits of the aggressive artery-opening strategy.

The findings have important implications for the older people who make up a large proportion of the more than 1.4 million patients who get emergency treatment for heart attacks and other severe cardiac problems each year in the United States, Bach said. This study included a larger number of older people than previous ones, he added.

The findings "will heighten awareness among clinicians" about the advantages of aggressive treatment," he said, and "they are something that may be reflected in future guidelines."

The results can't be applied to all older patients who require emergency heart treatment, Bach noted. The study excluded patients who had other major illnesses, such as cancer.

Dr. H. Vernon Anderson is a professor of medicine at the University ofTexas Health Science Center in Houston, and was involved with the study. The finding "adds a significant amount of credibility to the idea that older people can be treated aggressively with an interventional approach," he said.

There has been "hesitation in much of the medical community toward a more aggressive approach to older people" because of the risk of excess bleeding and other complications, Anderson said.

"The data from this study indicate that even with those problems, older people do better with an aggressive approach," he said.

More information

The American Heart Association has more on the signs and symptoms of a heart attack or other heart problems.

SOURCES: Richard G. Bach, associate professor, medicine, Washington University School of Medicine, St. Louis; H. Vernon Anderson, University of Texas Health Science Center, Houston; Aug. 3, 2004, Annals of Internal Medicine

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