American College of Cardiology

Contact: cfeheley@acc.org; 800-253-4636; 301-581-3425

February 4, 2004

“In short, 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,” said David A. Halon, MBChB, FACC from the Lady Davis Carmel Medical Center and the Bruce Rappaport School of Medicine, Technion, Israel Institute of Technology in Haifa, Israel.

The researchers followed 449 consecutive patients with acute coronary syndromes admitted to the Lady Davis Carmel Medical Center. The study group included 251 patients age 70 to 79 and 198 patients age 80 or older.

The very elderly patients (80 or older) were sicker. They were more likely to have had a heart attack, have heart failure or kidney problems than patients in their 70s. While clinicians were less likely to refer very elderly patients for angiography, the percentage of patients who eventually underwent angioplasty or bypass surgery to reopen coronary arteries was similar in both age groups.

Although very elderly patients were less likely to survive at least two years (67.4% vs. 83.5% of patients in their 70s), the patients in their 80s who did survive were more likely to report improved wellbeing.

“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,” Dr. Halon said.

The researchers said that this study looked at typical patients seen in routine hospital practice, as opposed to the carefully selected samples used in many trials involving elderly heart patients.

“The burden of coronary heart disease in the elderly is increasing rapidly in most or all Western countries and a similar picture to that described here would probably be found in many other hospital settings at the present time. However similar studies in other centers need to be done to confirm this,” Dr. Halon said.

Christopher P. Cannon, MD, FACC with Brigham and Women’s Hospital in Boston, Massachusetts, who was not involved in this research, said this study adds to evidence that clinicians should offer elderly patients the same sort of treatments they provide to similar, but younger, patients.

“In general there has been reluctance to treat the elderly, especially octogenarians, as aggressively as younger patients. Prior studies have found older patients receive less aggressive care. This study documents this very well for the octogenarians,” Dr. Cannon said. “However, these older patients are at higher risk of adverse outcomes and death (as shown in this study) and thus would be good candidates for more aggressive care. Thus there has been a paradox—that the elderly are higher risk (where our guidelines would say be more aggressive) yet they receive less aggressive care. 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.”

The American College of Cardiology, a 29,000-member nonprofit professional medical society and teaching institution, is dedicated to fostering optimal cardiovascular care and disease prevention through professional education, promotion of research, leadership in the development of standards and guidelines, and the formulation of health care policy.

The American College of Cardiology (ACC) provides these new reports of clinical studies published in the Journal of the American College of Cardiology as a service to physicians, the media, the public, and other interested parties. However, statements or opinions expressed in these reports reflect the view of the author(s) and do not represent official policy of the ACC unless stated so.