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Treatment Delays in Elderly Heart-Attack Patients Result from Strategic Thinking by Physicians

April 12, 2019

A new study finds that elderly people who suffer heart attacks may not receive the same level of care as younger individuals, and they may face longer delays in getting that care.

A team at Mount Sinai St. Luke’s and Mount Sinai West Hospital in New York looked at 2014 data on more than 115,000 heart attack patients from across the country, just slightly more than half of whom were older than 65. They found that people in this age group were one-third less likely to undergo angioplasty, which is a procedure that uses a balloon-like tube to open a blocked artery. Angioplasty patients often get stents, devices also used to prop open blocked or narrowed passages; however, the study found that older people were 36 percent less likely to get stents, and they were 34 percent less likely to receive them within 48 hours of their heart attack. Time is critical when it comes to treating heart-attack victims, experts say.

Complications were more common in older heart-attack patients compared to younger ones. Their risk of developing heart failure was 62 percent higher, and their chances of going into shock were 28 percent higher. Their likelihood of cardiac arrest was 21 percent higher, and their risk of needing a ventilator was 10 percent above that of younger heart-attack patients.

But rather than signifying a general neglect of older heart patients, these findings demonstrate that providers often must allot extra time and factor in co-existing medical conditions when assessing the best course of action for a senior citizen having a heart attack, according to Barry Cohen, MD, medical director of the cardiac catheterization lab at Atlantic Health System and author of Coronary Heart Disease: From Diagnosis to Treatment, who was not involved in the study. “One of the most important things to keep in mind is that the older population is often sicker,” Dr. Cohen said. “Their conditions are often much more complicated, and for providers, that can mean treatment can’t be given right away.”

Conditions such as kidney disease, diabetes, heart failure or other cardiac problems can present obstacles to what would otherwise be straightforward heart-attack therapies, making it critical to take the time to do a risk assessment. “We’re not stalling, we’re strategically thinking about what is best for the patient, despite the desire to be under 90 minutes for door-to-angioplasty time,” Dr. Cohen said.