Note to editors: Dr. Peterson will discuss his findings at an American Heart Association press conference, to be held at 10:15 a.m. EST, Sunday, Nov. 7, in the AHA press room in the Georgia World Congress Center. He is also scheduled to present the study at 9:30 a.m., Monday, Nov. 8 in Room 214-215E at the conference.
ATLANTA--Contrary to what most physicians may expect, even very elderly people with heart blockages have better long term outcomes if treated with aggressive therapies such as heart bypass surgery or angioplasty, a Duke University Medical Center study has found.
Duke investigators found that patients aged 75 years and older who were given angioplasty or bypass surgery to treat multiple blocked arteries lived significantly longer than those who were treated conservatively with medicines only.
The study, the largest of its kind reported, has the potential for changing the way aged heart patients are treated, according to cardiologists who prepared their findings for presentation Sunday at the American Heart Association's annual scientific sessions. But they cautioned that the findings need to be confirmed with future randomized treatment comparisons.
Many physicians now avoid surgery or angioplasty in elderly heart patients because they worry these treatments may pose unacceptable risks, the researchers said. In addition, there had been no evidence from clinical studies to say whether these aggressive procedures provided any long-term benefits in older people because they almost always had been excluded from clinical trials testing these treatments.
"For patients over age 75, we have been flying blind," the lead investigator, Dr. Eric Peterson, said in an interview. "It has been unclear whether the very elderly, who are considered high risk patients simply because of their age, derive much benefit, including longer survival, from aggressive therapy. So physicians have tended to use it less. In fact, our group has found that a patient aged 80 with coronary disease is more than five times less likely to receive revascularization therapy than a similar 65-year-old patient.
"But this work shows us that the rule of thumb we use for treating younger patients also holds true for older ones: Patients with the greatest risk of dying from their heart disease stand to benefit the most from aggressive therapy," Peterson said.
Elderly patients -- those 75 and older -- account for about one-third of all heart attacks in this country, "yet we know so little about how to treat them appropriately," he said.
To conduct the study, Peterson and a team of researchers studied the medical records of 2,613 patients age 75-plus who had been treated at Duke from 1984 to 1996. These records had been kept in the Duke Database for Cardiovascular Disease, the most comprehensive compilation of heart treatment information in the world. In this study, the mean age of patients was 79 years old, 52 percent were female and the mean follow-up for this group was nearly eight years.
Using statistical modeling, the researchers examined the outcomes of patients who were paired with other patients who had comparable heart disease but different treatments. The researchers found:
- For an "average" 79-year-old patient with limited heart disease (one blocked vessel), seven-year survival curves were about the same for all treatments.
- In contrast, an average 79-year-old patient with two-vessel disease had 10 percent to 15 percent longer survival with revascularization than those who received conservative medical care.
This survival advantage with angioplasty or bypass surgery extended to 20 percent greater long-term survival when the patient had extensive (three vessel) coronary disease.
Peterson and his colleagues are currently studying the effects of heart therapies on long-term patient symptoms and functional status in the aged.
"While demonstrating that these treatments can extend life is important, patients also need to be assured that these therapies will also improve their quality of years," he said. "Until these studies are performed, the current study does suggest that even the very aged appear to benefit from more aggressive heart care."
The study was funded by the American Federation for Aging Research.