Patients over 80 can benefit from invasive heart attack treatment – study

Elderly patients suffering the most common type of heart attack may benefit from more invasive treatment, new research suggests.

The study looked at elderly patients admitted to hospital with a type of heart attack called Nstemi (non-ST segment elevated myocardial infarction).

It found those who underwent invasive treatment with a coronary angiogram, followed up with bypass surgery or coronary stenting as appropriate, had higher survival rates than those who were treated with medication alone.

Patients who had coronary angiograms – specialist X-rays to identify blockages in the blood supply to the heart – were also less likely to be re-admitted to hospital with a second heart attack or heart failure.

Coronary angiograms can help a clinician determine the cause of an Nstemi heart attack and decide on effective treatment, such as increasing blood flow through a coronary stent or bypass grafting.

Previous trials have shown increased survival rates in younger patients with Nstemi heart attacks following invasive treatment.

But there as been conflicting evidence as to whether patients over 80 can also benefit from this.

Only 38% of Nstemi patients in this older age group currently receive invasive treatment, compared to 78% of the under 60, researchers say.

Dr Amit Kaura, lead author of the research, British Heart Foundation (BHF) clinical research fellow and NIHR clinical research fellow with the National Heart and Lung Institute at Imperial College London, said: “Because there has been no clear consensus on how best to manage elderly patients with this type of heart attack, many doctors have erred on the side of caution, not wanting to risk complications in their more vulnerable patients.

“These results show they can now be more confident of the benefits that invasive treatment can bring for this group.”

The study uses data collected over seven years from 1500 patients aged 80 or over who were diagnosed with an Nstemi heart attack at five hospitals between 2010 and 2017.

It was conducted by researchers from the National Institute of Health Research Health Informatics Collaborative (NIHR-HIC), led by Imperial College Healthcare NHS Trust and Imperial College London.

Of the 1500 patients, 845 had invasive treatment.

After five years, 31% of those in the invasive treatment group had died, compared to 61% in the non-invasive group, according to the study published in the Lancet.

The researchers estimate that if all patients had received invasive treatment, just 36% would have died, compared to 55% if all had received non-invasive treatment.

These figures take into account over 70 variables that might have affected prognosis, such as other medical conditions.

The analysis also showed patients were at no greater risk of stroke or bleeding if they received invasive treatment, as the rates were similar across both groups.

Patients who had invasive treatment were also a third less likely to be re-admitted to hospital for heart failure or heart attack, the study suggests.

Dr Kaura said: “The gold standard is to base treatment decisions on evidence from randomised control trials, but that doesn’t yet exist for this group of patients.

“In the interim, we’ve done the next best thing, by looking at retrospective data gathered from these five large hospitals and using it like a clinical trial.

“The results are clear: clinicians should positively consider invasive management for any patients over 80 diagnosed with an Nstemi.”

Professor Sir Nilesh Samani, medical director at the BHF, said: “This research will give confidence to doctors on the best course of treatment for elderly people who suffer heart attacks.

“Decades of research has fine-tuned our understanding of how to best treat heart attacks and ensure people go on to live long and healthy lives.

“However, evidence around optimal treatments for older people over 80 has been less clear.”

He added: “While the decisions about the best way to treat any elderly patient will depend on their individual circumstance – this study shows that age alone should not be a barrier to patients receiving life saving procedures for heart attacks.”