Feature | March 24, 2015

Patients 80 Years and Older Would Benefit from Aggressive Treatment

Study suggests older patients may be denied invasive treatments unnecessarily

March 24, 2015 — Patients over age 80 with acute coronary syndromes would likely benefit from more invasive tests and therapies that may otherwise be denied them due to their age, according to research presented at the American College of Cardiology (ACC) 2015 annual meeting.
 
The study focused on treatment approaches for older patients with non ST-elevation myocardial infarction (NSTEMI — a type of heart attack that is milder in the acute phase, but has a poor prognosis after six months or more) or the closely related condition unstable angina. Both conditions are caused by the buildup of plaque in the heart’s arteries.
 
In the study, patients 80 years and older who received invasive procedures that are typically offered to younger patients to evaluate and correct narrowed arteries had a 47 percent reduction in the study’s primary endpoint, a combined measure of subsequent heart attacks, urgent revascularization procedures, stroke and death, as compared to similar patients who were treated using a more conservative approach.
 
“Because people over 80 are underrepresented in clinical trials, they are less likely to receive treatment according to guidelines,” said Nicolai Tegn, M.D., a cardiologist at Rikshospitalet Oslo University Hospital in Norway and the study’s lead author. “Our study, which directly targets the over-80 population, is the first to demonstrate that a more invasive strategy results in better outcomes in these patients. I believe our study provides a sufficient basis to recommend an invasive approach.”
 
The study included 458 patients who were treated for NSTEMI or unstable angina at 16 health centers in Norway. Patients were randomly assigned to receive one of two treatment approaches. Half received a conservative approach, which included medications as needed but no invasive interventions. The other half underwent coronary angiography, a test in which a catheter is threaded into the arteries of the heart to release a dye that makes the extent of plaque buildup visible in an X-ray. Based on the results of this test, doctors referred patients for balloon angioplasty and/or stenting in which plaque blocking the arteries is pushed aside, heart bypass surgery in which narrowed coronary arteries are replaced by arteries grafted from elsewhere in the body, or non-invasive treatments, such as drugs.
 
Of the 225 patients receiving coronary angiography, 48 percent were subsequently treated with angioplasty or stenting and 3 percent were treated with bypass surgery. In a median follow-up time of 18 months, the group receiving coronary angiography showed a 47 percent reduction in the study’s primary endpoint — a composite of heart attack, urgent revascularization procedures, stroke and death. The study did not show significant differences in the secondary endpoint (death from any cause) or in the risk of bleeding complications.
 
According to U.S. life expectancy statistics, a person who reaches age 80 can expect to live an average of 8.2 years (in men) and 9.7 years (in women). 
 
“The ‘80-plus’ population is an extremely heterogeneous group, ranging from healthy individuals to people with severe illness,” Tegn said. “The fact that many 80- year-olds have nearly a decade of life ahead of them makes these results particularly noteworthy.” 
 
Acute coronary syndromes become more common with age. It is estimated that as many as four out of five Americans over age 80 have at least one of a variety of conditions related to the buildup of plaque in the heart’s arteries. NSTEMI and unstable angina are often managed with a combination of medications, lifestyle changes and dietary changes in older people. Coronary angiography testing, stenting and bypass surgery are typically offered less often for the elderly than for younger patients, though practices vary depending on physician preference and clinic capabilities. 
 
The researchers will continue to track patients’ outcomes over the coming years.
 
For more information: acc.org
 

Related Content

New FDA Proposed Rule Alters Informed Consent for Clinical Studies
News | Cardiovascular Clinical Studies | November 19, 2018
The U.S. Food and Drug Administration (FDA) is proposing to add an exception to informed consent requirements for...
A key slide from Elnabawi's presentation, showing cardiac CT plaque evaluations, showing the impact of psoriasis medication on coronary plaques at baseline and one year of treatment. It shows a reversal of vulnerable plaque development. #SCAI, #SCAI2018

A key slide from Elnabawi's presentation, showing cardiac CT plaque evaluations, showing the impact of psoriasis medication on coronary plaques at baseline and one year of treatment. It shows a reversal of vulnerable plaque development.  

Feature | Cardiovascular Clinical Studies | May 14, 2018
May 14, 2018 – New clinical evidance shows common therapy options for psoriasis (PSO), a chronic inflammatory skin di
Intravenous Drug Use is Causing Rise in Heart Valve Infections, Healthcare Costs. #SCAI, #SCAI2018
News | Cardiovascular Clinical Studies | May 14, 2018
May 14, 2018 — The opioid drug epidemic is impacting cardiology, with a new study finding the number of patients hosp
Patient Enrollment Completed in U.S. IDE Study of THERMOCOOL SMARTTOUCH SF Catheter
News | Cardiovascular Clinical Studies | March 15, 2018
March 15, 2018 –  Johnson & Johnson Medical Devices Companies announced today that Biosense Webster, Inc., who wo
Lexington Begins HeartSentry Clinical Trial
News | Cardiovascular Clinical Studies | February 20, 2018
February 20, 2018 – Lexington Biosciences, Inc., a development-stage medical device company, announced the commenceme
Endologix Completes Patient Enrollment in the ELEVATE IDE Clinical Study
News | Cardiovascular Clinical Studies | February 06, 2018
February 6, 2018 – Endologix, a developer and marketer of treatments for aortic disorders, announced the completion o
12-Month Results from Veryan Medical's MIMICS-2 IDE Study Presented at LINC
News | Cardiovascular Clinical Studies | February 01, 2018
February 1, 2018 – Thomas Zeller (Bad Krozingen, Germany) presented the 12-month results from Veryan Medical’s MIMICS
LimFlow Completes U.S. Feasibility Study Enrollment, Receives FDA Device Status
News | Cardiovascular Clinical Studies | February 01, 2018
February 1, 2018 –  LimFlow SA, developer of minimally-inv
ESC 2017 late breaking trial hot line study presentations.
News | Cardiovascular Clinical Studies | September 12, 2017
September 12, 2017 – The European Society of Cardiology (ESC) Congress 2017 includes several Hot Line Late-breaking C
U.K., NHS studies, weekend effect, hospital admission, atrial fibrillation, heart failure
News | Cardiovascular Clinical Studies | June 28, 2016
New research shows patients admitted to National Health Service (NHS) hospitals in the United Kingdom for atrial...
Overlay Init