Comparing treatment approaches in elderly patients with heart attack

Reported by Susan Aldridge, PhD, medical journalist

A new survey suggests that management of heart attack in elderly patients is not optimal.
When someone has a heart attack, there are two approaches to treatment - medical and invasive. The former involves giving drugs like aspirin, beta-blockers,and thrombolytics, which dissolve the clot causing the heart attack. Invasive treatments are bypass operations or angioplasty, which both open up the blocked artery. In practice, a combination of both medical and invasive treatment may be used, and there may be differences in the intensity of the treatment offered.

A team at Dartmouth Medical School now reports on nearly 160,000 elderly patients with heart attack, the kind of treatment they received,and how they fared during seven years of follow up. In general, younger and healthier patients were more likely to receive intensive treatment and medical therapy. Where a region had facilities like cardiac catheterization, which enables angioplasty, patients were more likely to have invasive therapy, despite their risk factors or age.

The researchers also learned that lower risk patients were on the whole more likely to receive invasive treatments than higher risk patients. However, this flies in the face of evidence that shows the higher risk patient actually has more to gain from invasive treatment. More intensive management was associated with increased survival, whether or not invasive treatment was used. Given the variation in practice and ongoing debate over how to manage patients after a heart attack, the researchers say it is time to develop national clinical guidelines on this issue.

Source
Journal of the American Medical Association 16th March 2005 Volume 293 pages 1329-1337