Age no standards for selections on coronary heart assault remedy, new analysis finds

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Age no criteria for decisions on heart attack treatment, new research finds

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Older people, who suffer from the most common type of heart attack, may benefit from more invasive treatment, new research has shown.

The study is based on data collected over seven years from 1,500 patients aged 80 and over. It was carried out by researchers from the National Institute of Health Research (NIHR-HIC), led by the Imperial College Healthcare NHS Trust and Imperial College London.

The study looked at elderly patients who were hospitalized with a type of heart attack called NSTEMI (increased myocardial infarction without an ST segment). It found that patients who underwent invasive treatment with a coronary angiogram followed by bypass surgery or coronary stenting had higher survival rates than those who were treated with medication only. Patients with coronary angiograms were also less likely to be re-hospitalized with a second heart attack or heart failure.

Coronary angiograms are special x-rays used to identify blockages in the blood supply to the heart. You can help a clinician determine the cause of an NSTEMI heart attack and decide on an effective treatment, such as: B. Increasing blood flow through a coronary stent or bypass graft.

Previous studies have shown increased survival rates in younger patients with NSTEMI myocardial infarction after invasive treatment, but there is conflicting evidence as to whether these benefits extend to patients over 80. Currently, only 38 percent of NSTEMI patients in this older age group are receiving invasive treatment compared to 78 percent of those under 60.

Dr. Amit Kaura, lead study author, British Heart Foundation Clinical Research Fellow and NIHR Clinical Research Fellow at the National Heart and Lung Institute at Imperial College London, stated, "There was no clear consensus on how best to treat elderly patients in this species of heart attack, many doctors were on the caution side, and did not want to risk complications in their more vulnerable patients. These results show that they can now be more confident about the benefits invasive treatment can bring to this group. "

The study, funded by the NIHR Imperial Biomedical Research Center, identified nearly 2,000 patients over the age of 80 who were diagnosed with NSTEMI heart attacks in five hospitals between 2010 and 2017. To ensure the robustness of the study, the researchers used sophisticated statistical techniques to apply the type of criteria used in a clinical study to determine which of these patients would be included in the analysis.

A total of 1500 patients were included, slightly more than half of whom were treated invasively. After five years, 31 percent of patients in the invasive treatment group had died compared with 61 percent in the non-invasive group.

The team estimates that if all patients had been treated invasively, only 36 percent would have died, compared with 55 percent if all had received non-invasive treatment. These numbers take into account over 70 variables that could have influenced the forecast, such as: B. other diseases.

The analysis also showed that patients were not at a higher risk of stroke or bleeding when they received invasive treatment, as the rates were similar in both groups. Patients on invasive treatment were one-third less likely to be hospitalized for heart failure or heart attack.

Dr. Kaura said, "The gold standard is to base treatment decisions on evidence from randomized controlled trials, but that doesn't exist for this group of patients. In the meantime, we've done the next best thing by looking at this." retrospective data collected from these five major hospitals and used as a clinical study. The results are clear: Physicians should positively consider invasive management for all patients over 80 who have been diagnosed with NSTEMI. "

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Provided by
Imperial College London

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Age no criteria for heart attack treatment decisions, new research (2020, August 27)
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