Emergency Care Lacking for Patients Over 90

Too often, doctors don't provide recommended heart attack treatments, study finds

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TUESDAY, April 24, 2007 (HealthDay News) -- Patients aged 90 and older suffering from angina or heart attack are less likely than younger patients to receive recommended medical treatments in hospital emergency rooms -- even though older patients are more likely to survive if they do receive the treatments, a U.S. study finds.

"Having an acute coronary syndrome, even over the age of 90, is not as dire as it once was. With optimal medical therapy and invasive care, the outcomes were nearly as good as in a somewhat younger group of patients," study author Dr. David J. Cohen, director of cardiovascular research at Saint Luke's Mid-America Heart Institute in Kansas City, Mo., said in a prepared statement.

The study is published in the May 1 issue of the Journal of the American College of Cardiology.

Acute coronary syndrome -- which includes a type of heart attack called non ST-segment elevation myocardial infarction (NSTEMI) and unstable angina (chest pain) -- is often caused by a blood clot that temporarily or partially blocks the coronary artery, according to background information in the article.

Recommended therapies include aspirin to prevent clotting; a blood thinner called heparin that also prevents clotting; and beta blocker drugs that slow the heart rate, reduce the force of the heart's contraction, and prevent rhythm abnormalities. The guidelines also recommend that high-risk patients receive cardiac catheterization within 48 hours, along with drugs called glycoprotein IIb/IIIa inhibitors to prevent clotting during or after cardiac catheterization.

In this study, the researchers analyzed data from a national study on almost 52,000 patients age 75 and older with acute coronary syndrome. More than 5,500 were at least 90 years old, and 112 were at least 100 years old.

Age was a major factor in the use of recommended therapies. For example, cardiac catheterization was considered inadvisable in almost 60 percent of patients age 90 and older, compared to 27 percent of patients age 75 to 89.

Cohen noted that the national study found the risk of major bleeding increases with the more therapies that are used to treat acute coronary syndrome -- from a 3.5 percent risk with one treatment to a 17.3 percent risk with five treatments.

However, patients who receive more therapies -- particularly aspirin, beta blockers and cardiac catheterization -- have a better chance of survival.

"The data are telling us that the balance favors survival, and we have to be willing to tolerate some increased bleeding. We shouldn't simply, on the basis of age, say a person is too high-risk. We should discuss these therapies with patients and their families," Cohen said.

Cohen has received research grants from Bristol-Myers Squibb, Sanofi-Aventis, and Eli Lilly, which all make anti-clotting drugs.

More information

The American Heart Association has more about acute coronary syndrome.

SOURCE: American College of Cardiology, news release, April 24, 2007

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