Age No Bar to Aggressive Rx for Cardiogenic Shock
MONDAY Feb. 16, 2009 -- Age shouldn't prevent the aggressive treatment of elderly patients with heart attack complicated by cardiogenic shock, Australian researchers report.
Cardiogenic shock (CS) occurs when the heart fails to supply enough blood to the body's organs. It is the most common cause of death after heart attack among Americans over the age of 75.
There's typically been widespread reluctance to use invasive treatments on elderly heart patients. However, this study found that elderly patients with heart attack complicated by CS who underwent percutaneous coronary intervention (PCI) had a one-year survival rate similar to that of younger patients.
"Elderly patients who are admitted to the hospital with massive heart attacks may still benefit from emergency coronary artery balloon angioplasty with stenting, despite their advanced age. Although mortality occurs in roughly half of patients in these high risk situations, without this aggressive treatment, the prospect of survival is very poor," study senior author David Clark, an interventional radiologist at Austin Hospital in Melbourne, said in an American College of Cardiology news release.
He and his colleagues analyzed data on 143 heart attack patients, including 45 elderly patients, treated between 2004 and 2007. The elderly patients were more likely to be female and to have hypertension, kidney failure, multi-vessel coronary artery disease and to have a had a previous heart attack.
There were no significant differences between the elderly and younger patients for in-hospital, 30-day and one-year death rates, the researchers reported in the February issue of the Journal of the American College of Cardiology: Cardiovascular Interventions.
"A patient's age in and of itself should not be used to deny someone more aggressive, invasive care with angioplasty for cardiogenic shock," Dr. Judith S. Hochman, a professor of cardiology and director of the Cardiovascular Clinical Research Center at the New York University School of Medicine, said in an American College of Cardiology news release.
"Having said that, we need to better understand and standardize criteria to improve selection of older patients who are likely to benefit. For example, as shown in this study, kidney function clearly is a useful indicator that a patient will do well. What we don't want is to subject patients to uncomfortable, unnecessary procedures if they will not derive a benefit in terms of quality of life or life prolongation," Hochman said.
The U.S. National Heart, Lung, and Blood Institute has more about seniors and heart attack.
Posted: February 2009
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