Older patients receive less evidence-based cardiac care than younger patients

People in their 80s and 90s are more likely to develop acute coronary syndrome than their younger counterparts. Despite this, they receive less therapy and fewer diagnostic procedures. A doctoral thesis at Sahlgrenska Academy has explored the topic.

Previous studies have shown that older patients are less likely to receive the most evidence-based, recommended treatment for acute coronary syndrome. Regarding the elderly, quality and quantity of the underlying scientific evidence is limited.

Age-related treatment

A number of recent studies by researchers at Sahlgrenska Academy have included more than 45,000 elderly cardiac patients. Presented in Dr. Berglind Libungan's doctoral thesis, the studies found that treatment of patients with symptoms of acute coronary syndrome, to some extent, is age-related.

Although patients in their 80s and 90s with chest pain are more likely to have a final diagnosis of acute coronary syndrome, doctors administer fewer angiograms, echocardiograms and offer less medical therapy compared with their younger counterparts. However, there was no delay to hospitalization or therapy when compared to younger patients.

"I presume that older patients receive less evidence-based treatment because the treating physician feels that the risks outweigh the benefits," Dr. Libungan says.

The risk for death among older patients with myocardial infarction who are treated with medical therapy is higher than among patients who have coronary angioplasty.

"Given the major differences between various patient groups, this finding does not mean that interventions are automatically better," Dr. Libungan says. "Patients who are treated with medication alone are usually older and in poorer health. Additional clinical research is needed to determine the strategy that works best for older patients."

The number of elderly Swedes with myocardial infarction treated with balloon angioplasty has increased over the past decade. Even though they are generally older and sicker, the risk for complications has not increased.

"The evidence suggests that more elderly patients could be offered balloon angioplasty," Dr. Libungan says.

Higer mortality rate

The new studies have also found that elderly patients who suffer cardiac arrest have a higher mortality rate which increases with age. The survival rate is 6.6% among 70-80 year-olds, 4.4% among 80-90 year-olds and 2.3% among those older than 90.