Older Heart Patients Do Well With Drugs
Surgery to Treat Heart Attacks Often Unneeded, Study Shows
March 15, 2005 - Too few elderly patients are getting appropriate drug treatment after having a first heart attack, and too many are being treated with surgical procedures they may not need, new research suggests.
In a study of regional differences in care among older heart attack patients, researchers reported that those who received optimal, inexpensive drug therapy after a heart attack fared almost as well as those who had surgical procedures such as catheterization.
"The bottom line is that if a heart attack is being managed properly using drugs then there appears to be no survival benefit for (surgery) unless you are talking about specific subgroups of patients," researcher Therese A. Stukel, PhD, tells WebMD.
Each year, about 280,000 Americans aged 65 and older have heart attacks. These patients face a high risk of short-term death with almost one in five dying within a month, write the authors.
Studies looking to reduce the high risk of death following a heart attack have shown that elderly or high-risk patients benefit from more invasive procedures.
For patients who survive, treatment decisions after a heart attack may have less to do with a person's risk of death than their age and where they live, Stukel and colleagues from Dartmouth Medical School report.
Their review included almost 160,000 Medicare patients from all over the U.S. followed for an average of seven years after having a first heart attack.
The study is reported in the March 16 issue of The Journal of the American Medical Association.
The researchers found that younger and generally healthier patients tended to have the more invasive surgical procedures like cardiac catheterization and angioplasty more often than patients over age 75. This was true even though their risk of dying from heart disease is much lower than the older patients.
And, not surprisingly, patients treated at hospitals with high-tech heart facilities received surgery and other high-tech treatments more often.
The difference in survival at seven years between the patients in regions that got the most aggressive treatment (high rates of surgery and medical therapy) and the regions with the lowest rates of both was 6.2%.
The survival difference was much smaller when patients treated with optimal combinations of drugs were compared with those who were treated surgically.
The study is not the first by the Dartmouth research group to question the superiority of some of the most aggressive medical treatments.
"Our message is that more health care does not necessarily equal better health care," Stukel says. "Drug therapy is inexpensive and noninvasive, and there is a lot of evidence showing that it works. There are clear guidelines identifying patients who benefit from early invasive therapy, but they aren't being followed."