Heart surgery improves quality of life in the aged

Elderly patients with heart disease who undergo coronary revascularization surgery enjoy better long-term health status and quality of life than those who are managed medically with drug therapy, according to results of a study.

The high burden of heart disease in the elderly, combined with reports of poor outcomes following bypass surgery or percutaneous coronary intervention (PCI) such as balloon angioplasty, have led to some "uncertainty as to whether these procedures should be routinely offered to elderly patients," note study investigators.

"More recently, however, significantly improved outcomes associated with revascularization procedures have been noted in both a small, randomized trial and a large observational study," Dr. Michelle M. Graham, of the University of Alberta Hospital, Edmonton, Canada, and colleagues point out.

In the present study, they examined the heath status at 4 years for a group of elderly patients with cardiac disease registered in the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) initiative.

A total of 21,573 patients in Alberta underwent catheterization, an invasive test that looks for coronary blockages, between 1995 and 1998 and most were surveyed 1, 3 and 5 years afterward. Crude and risk-adjusted outcomes were determined and compared for patients treated with angioplasty or bypass surgery versus medical therapy.

Among patients younger than 70 years and those between 70 and 79 years, scores on all dimensions of the Seattle Angina Questionnaire were significantly better for patients treated with revascularization surgery than with medical therapy.

Among patients older than 80 years, scores were significantly better for patients treated with bypass surgery.

All scores were stable or improved at 3 years, and they continued to favor revascularization.

"These findings imply that the benefits of revascularization procedures performed in appropriately selected elderly patients extend not only to clinical outcomes, but also to long-term enhancement of quality-of-life," Graham's team concludes.

Therefore, "age should not deter against revascularization."

SOURCE: European Heart Journal July 2006.