Drugs, surgery comparable for angina in elderly

Drug therapy is just as good as surgery in prolonging the lives of elderly patients with angina, a type of chest pain caused by reduced blood flow to the heart, new research suggests. However, patients treated with drug therapy were more likely to experience non-fatal heart attacks and other events.

The findings are based on a study of 276 patients who participated in the Trial of Invasive versus Medical Therapy in the Elderly (TIME) trial and had survived at least 1 year. The report appears in Circulation: Journal of the American Heart Association.

At enrollment, the group was 42 percent female with an average age of 80 years. Despite being treated with an average of 2.5 drugs to control their angina, the subjects still had relatively severe symptoms.

Survival at 6 months, 1 year, and 4 years was similar regardless if the patient had received drug therapy or a more invasive treatment, such as bypass surgery or angioplasty, lead author Dr. Matthias Pfisterer, from University Hospital in Basel, Switzerland, and colleagues note.

As expected, survival rates decreased during follow-up - rates at 6 months hovered around 93 percent, whereas rates at 4 years were around 72 percent.

Predictors of poor survival included age of 80 years or more, prior heart failure, and reduced heart-pumping ability.

Both types of therapy provided lasting benefits in quality of life and angina relief. As noted, however, the "invasive" therapies were apparently better than medical therapy at preventing non-fatal heart attacks and related events.

"Our results show that long-term mortality is similar in invasively treated patients and those treated with optimal drug therapy," Pfisterer said in a statement. "Chest pain relief and improved quality of life are also similar, but invasively managed patients reach this benefit earlier."

SOURCE: Circulation, August 31st online issue, 2004.