Dr. Berglind Libungan’s doctoral thesis at Sahlgrenska Academy explores the topic of older patients and how despite the fact they are more likely to develop acute coronary syndrome than their younger counterparts, they receive less therapy and diagnostic procedures.
Previous studies have also shown that older patients receive less evidence-based recommended treatment for acute coronary syndrome; scientific evidence regarding this is however limited.
Dr. Libungan’s thesis presents a number of studies conducted by researchers at Sahlgrenska Academy involving more than 45,000 elderly cardiac patients. The findings of these studies show that treatment of patients with symptoms of acute coronary syndrome, to some extent, is age-related. Patients in their 80s and 90s are more likely to have a final diagnosis of acute coronary syndrome but they have less angiograms, echocardiograms and receive less medical therapy as compared to younger patients. The studies also show that older patients who suffer cardiac arrest have a higher mortality rate. This rate increases with age – 6.6% among 70-80 year-olds, 4.4% among 80-90 year-olds and 2.3% among those older than 90. There was no significant difference in hospitalisation or therapy between younger or older patients.
"I presume that older patients receive less evidence-based treatment because the treating physician feels that the risks outweigh the benefits," Dr. Libungan says.
Risk of death among older patients with myocardial infarction and treated with medical therapy is higher as compared to patients who are treated with an intervention. Dr. Libungan points out though that this does not mean interventions are automatically better but that patients who are treated with medication alone are likely to be older and in poorer health.
The number of elderly patients in Sweden with MI and treated with balloon angioplasty has increased and the risk for complications has not increased. This suggests that more elderly patients could be offered balloon angioplasty.
Image Credit: Berglind Libungan, PhD Student, University of Gothenburg