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Older Heart Patients Treated Less Aggressively
Reuters Health
October 18, 2005
Elderly patients seeking emergency treatment for a heart attack or chest pain are less likely than younger patients to receive many of the therapies that professional guidelines call for, a large U.S. study suggests.
Past studies have found that elderly adults with heart disease are less likely to receive aggressive treatment. In response, recent treatment guidelines have emphasized the fact that age alone should not determine whether emergency patients get blood-clot-dissolving drugs or invasive procedures.
However, the new study, of patients at 443 U.S. hospitals, found that the older patients were, the less likely they were to receive these therapies -- even when their overall health was taken into account.
Researchers led by Dr. Karen P. Alexander, of Duke University Medical Center in Durham, North Carolina, report the findings in the Journal of the American College of Cardiology.
The study included nearly 57,000 patients treated between 2001 and 2003 for an acute coronary syndrome -- a heart attack or unstable angina, a form of chest pain that can signal an impending heart attack.
Overall, the researchers found, older patients were less likely to receive quick treatment with blood-thinning and clot-busting medications. For example, while 45 percent of patients younger than 65 received the drug clopidogrel soon after hospital admission, the same was true of only 35 percent of patients between the ages of 75 and 84, and just 30 percent of those age 85 or older.
Similarly, older patients were less likely to receive invasive procedures like angioplasty, in which a balloon-tipped catheter is threaded into an artery to clear any blockages obstructing blood flow to the heart.
This was despite the fact that all patients, young and old, were less likely to die in the hospital when they received more-aggressive treatment, the study found.
It is understandable, according to Alexander and her colleagues, that doctors may hesitate to use certain therapies for elderly patients. In general, the elderly are at greater risk of treatment complications, and are more likely to have medical conditions, such as severe high blood pressure or a history of stroke, that make certain therapies inappropriate.
But even when the researchers took those factors into account, elderly heart patients were still less likely to receive guideline-recommended treatments.
"Safety concerns," the study authors write, "should be considered in light of the potential harm caused by withholding effective therapies in high-risk elderly patients."
The research was funded by several drug firms, and some of the study authors have received research grants from the companies.
SOURCE: Journal of the American College of Cardiology, October 18, 2005.
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