People over 80 may benefit from angioplasty, bypass surgery too: study
August 3, 2010
Anne-Marie Tobin
THE CANADIAN PRESS
More octogenarians are surviving heart attacks and part of the credit may rest with procedures such as bypass surgery and angioplasty, a new Canadian study suggests.
An American expert on surgery in the elderly says work in this area led by a team at McGill University Health Centre is important in light of current demographics. An article on the Montreal research was published Tuesday by the Canadian Medical Association Journal.
“I’ve asserted for years that we’re not paying close enough attention to the aging of the population and what effect that will have on medical care,” said Dr. Mark Katlic, a thoracic surgeon who has authored a textbook on surgery in seniors and who wrote a commentary on the McGill study that also appeared in the journal.
“This paper today from McGill clearly demonstrates that we will be doing more and more of these aggressive procedures on patients over the age of 80,” he said from Wilkes-Barre, Pa., where he is with Geisinger Health System.
The leading edge of the baby boomers, the post-Second World War bulge in the population, is creeping ever closer to the seven-decade mark in both Canada and the U.S.
“I believe that the aging of our population will be the greatest force affecting health care in our lifetime, and I’m not sure that anybody’s taking it quite seriously enough,” Katlic said.
A database of hospital discharge summaries was used to identify patients aged 80 or older admitted to hospitals in Quebec after a heart attack from March 1996 to March 2007. Altogether, there were 29,750 patients.
The rate of death within one year of a heart attack among the patients studied dropped from 48.4 per cent in 1996 to 30 per cent at the end of the study. One-year mortality remained unchanged in a subgroup of patients who didn’t undergo revascularization.
Senior author Dr. Louis Pilote said the use of therapeutic interventions — in particular angioplasty to open blockages with a balloon or stent, or bypass surgery — has increased in elderly patients. And technologies have improved as well, she said.
“Earlier on, it was felt that elderly people might be more at risk of basically not benefiting from these procedures because of the fact that they were at high risk, but as the technology is improving and as we’re seeing that these elderly people might benefit from an aggressive approach, we’ve been using it more,” said Pilote, who is director of the division of general internal medicine at the health centre.
“We’re seeing a decrease in mortality in these elderly patients and at the same time as the increased use, this change in the approach. So we’re thinking that the increase in use of those procedures has led to a decline in the mortality of those elderly patients,” she said in an interview from Montreal.
The use of angioplasty jumped from 2.2 per cent to 24.9 per cent during the period studied. The use of heart medications also increased and may have contributed to higher survival rates after one year, the study said.
The profile of these very elderly patients changed over the time period too, it showed.
“The so-called co-morbidities, the diabetes, the cancers, hypertension, chronic renal failure, all of those were increased in the later group of patients, so these were sicker patients, and yet the results still were better,” Katlic observed.
“And so there certainly is a strong suggestion that these interventions have helped these 80-year-old patients.”
He noted, however, that the study doesn’t prove that this is the case and more work is needed to answer that question.
Dr. Roy Masters, a cardiac surgeon at the University of Ottawa Heart Institute, said the article and commentary are “really quite well done” and the timing is appropriate.
“I think many of us in cardiac surgery and cardiology have noticed over the last number of years that we are seeing older patients coming for surgery, in my case, and more and more (have) co-morbidities, if you will — co-existing conditions when they do come to us. And quite to our surprise, most of them do really quite well,” said Masters.
“So it really is putting on paper what many of us have thought has been happening all along. And in fact, here at the Heart Institute, we have been analyzing our own data and we have found very similar findings as theirs.”
The research provides fodder for discussion, he indicated, noting that many people feel that just because somebody is 75 or 80 or 85 that they will never tolerate heart surgery or angioplasty and “that’s clearly not the case.”
But he said the elderly don’t have a lot of tolerance if things go wrong. For instance, pneumonia after heart surgery could cause serious problems in an older patient, whereas a younger patient might be able to fight it off with antibiotics.
A discussion needs to take place at many levels, involving governments and policy makers, he said.
“It’s something that society will have to deal with for sure, because it is an increased burden on the system, not just having the procedure itself but elderly people require longer in hospital, more intensive care services are required.”
Pilote, too, said the findings should be used to spark a discussion.
“In terms of health services, in terms of the health care system and the ability to deal with those baby boomers, we’ll be needing those procedures as they age. It requires we look at whether we have the capacity for this type of treatment,” she said.