Elderly patients suffering the most common type of heart attack
may benefit from more invasive treatment, new research has shown.
The study draws on data captured over seven years from 1500
patients aged 80 or over. 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.
The research looks at elderly patients admitted to hospital
with a type of heart attack called NSTEMI (non-ST segment
elevated myocardial infarction). It found patients 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 were also less likely to be
re-admitted to hospital with a second heart attack or heart
failure.
Coronary angiograms are specialist X-rays to identify
blockages in the blood supply to the heart. They 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 and setting the
optimum level of medication.
Previous trials have shown increased survival rates in
younger patients with NSTEMI heart attacks following invasive
treatment, but there has been conflicting evidence as to whether
these benefits extend into patients over 80. Only 38 percent of
NSTEMI patients in this older age group currently receive
invasive treatment, compared to 78 percent of the under
60s.
Dr Amit Kaura, lead author of the research, British
Heart Foundation Clinical Research Fellow and NIHR Clinical
Research Fellow with the National Heart and Lung Institute at
Imperial College London explained: “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 further 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, funded by the NIHR Imperial Biomedical
Research Centre, identified just under 2000 patients aged
over 80 who were diagnosed with an NSTEMI heart attack at five
hospitals between 2010 and 2017. To ensure the robustness of the
study, the researchers applied the kind of criteria used in a
clinical trial, to determine which of these patients would be
included in the analysis.
In total, 1500 patients were included, with just over half
having invasive treatment. After five years, 31 percent of those
in the invasive treatment group had died, compared to 61 percent
in the non-invasive group.
The team estimate that if all patients had received
invasive treatment, just 36 percent would have died, compared to
55 percent if all had received non-invasive treatment. These
figures take into account over 70 variables across the group that
might have affected prognosis, such as other medical
conditions.
The analysis also showed that patients were at no greater
risk of stroke or bleeding if they received invasive treatment,
as there were similar rates 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.
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.”
The data used in the study was gathered through the
National Institute for Health Research Health Informatics
Collaborative (NIHR-HIC), which involves: Imperial College
Healthcare NHS Trust, Oxford University Hospitals NHS Foundation
Trust, University College London Hospitals NHS Foundation Trust,
King’s College Hospital NHS Foundation Trust and Guy’s and St
Thomas’ NHS Foundation Trust.
