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Elderly Patients Benefit from Aggressive Heart Treatment

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Duke Health News 919-660-1306

ATLANTA, G.A. -- 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."

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