Too Old for a Bypass?
No. So why are the elderly turned down for heart surgery?
Getting Good Outcomes continued...
Mortality data is gathered by the Health Care Financing Administration, which administers Medicare. Various organizations then analyze and distribute the findings.
The low mortality rates at The Heart Hospital, Sternlieb says, are not just due to careful selection of patients but also to the unique design of the facility -- one of the few hospitals in the country devoted solely to heart surgery. The posh 12-bed facility is set up to allow instant life-saving interventions and round-the-clock monitoring. Even when off-duty, Sternlieb keeps an eye on his patients' hearts from remote monitors set up in his nearby home. The doctor sometimes even spends the night in a patient's room. (And, it's generally acknowledged that patients who have had access to lifelong quality medical care have better odds of success, too.)
While he has shown it's possible to perform heart surgeries safely on older patients, Sternlieb cautions that there is still a risk, and that the risk can be unacceptably high in many facilities.
(Consumers can check out a facility in advance. The Healthgrades site, for instance, has an eight-page report on how to select a hospital. The Joint Commission on Accreditation of Healthcare Organizations (www.jcaho.org) grades hospitals nationwide.)
The decision to do bypass surgery must always be decided on an individual basis, Sternlieb says. "An 80-year-old doesn't have the reserves of a younger patient and can't afford as many complications," he says. Elderly women, especially, can be at high risk due to their smaller arteries and increased frailty.
Ultimately, Sternlieb says, his older patients may do better emotionally than their younger counterparts. Patients 80 and older spend less time anguishing over the surgery, require less hand-holding, and are not nearly so anxious about mortality, he says.
Albert Carlsen advises others his age: "If you need the operation, by golly, have it done. I'm very glad I did."
Alexander, the study author, sees his point. "As we're getting more experience and more knowledge about outcomes in this age group, we're finding there's no reason to exclude people offhand because of age."
Ann Japenga is a contributing editor to Health magazine and a former Los Angeles Times reporter. She lives in Palm Springs, Calif.