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Effectiveness of heart therapy linked to age

Effectiveness of heart therapy linked to age

People who are 90 years or older who suffer a heart attack or other acute coronary event can tolerate and are likely to respond to recommended heart therapies with improved outcomes, research suggests.
Dr. David J. Cohen from Saint Luke's Mid America Heart Institute, Kansas City, Missouri and colleagues examined contemporary treatment and outcomes of acute coronary syndromes among the "older" elderly (90 or older), compared with the "younger" elderly (75 to 89 years).
For very elderly patients without overt complications, the treatments that are critical for younger patients, like aspirin and surgical procedures, are the same for the elderly, they point out.
They found that increased adherence to recommended treatment guidelines was associated with a progressive decline in death rates in both groups. More extensive use of therapies with the potential to increase bleeding was directly related to the risk of major bleeding in both age groups.
"Even though the very elderly patients are at high risk of bleeding from aggressive medical therapy for acute coronary syndromes, their mortality actually decreases with more aggressive care," Cohen said. "Thus, the increased risk of bleeding appears to be a price that is worth paying in order to optimize outcomes for this increasingly important (yet understudied group of patients)."
"The main differences between the very elderly and younger groups of patients relate to their increased risk of all complications during a hospitalization from acute coronary syndromes," Cohen added.
The older group was more likely to have contraindications to recommended medications, like statins and blood-thinners, and to cardiac procedures than the younger group, the authors also found.
However, for patients without contraindications, the older elderly were significantly less likely to receive several heart medications in the first 24 hours after admission, and they were only about one third as likely to undergo cardiac procedures within the first 48 hours of presentation.
The older group was more likely than the younger group to die or experience an adverse cardiovascular outcome during the hospitalization.
Interestingly, the investigators point out, the adjusted risks of in-hospital stroke and major bleeding were lower among the older elderly than among the younger elderly patients.


Updated : 2021-04-21 19:39 GMT+08:00