Up-to-date observations in older hearts

It turns out that Isley’s brothers, who sang this Motown from 1966, “This is my elderly heart (it is frail for you)”, they were on something when they combined age with a sore and meaning heart.

Heart disease, the leading cause of the death and disability of the nation, was diagnosed in about 6 percent of Americans aged 45 to 64, but in over 18 percent of people over 65 years elderly, According to Centers for Disease Control and Prevention.

Senior hearts are physiologically different. “The heart becomes stiffer as he ages,” said Dr. John Dodson, director of the Geriatric Cardiology Program at Nyu Langone Health. “It is not so easily filled with blood. The muscles are also not relaxed. “

Age also changes blood vessels that can grow immovable and cause hypertension, and nerve fibers that send electrical impulses to the heart. It also affects other organs and systems that also play a role in cardiovascular health. “After 75 it is when the things are accelerating,” said Dr. Dodson.

But in recent years, the dramatic improvement of the treatment of many types of cardiovascular conditions has helped to reduce both heart attack AND heart deaths.

“Cardiology has been blessed with great progress, research and drug development,” said Dr. Karen Alexander, who teaches geriatric cardiology at the Duke University. “Drugs are better than ever and we know how to apply them better.”

However, this may complicate decisions for patients with heart in the 70s and later. Some procedures or schemes may not significantly extend the lives of older patients or improve the quality of their other years, especially if they have already experienced heart attacks and are fighting other diseases.

“We don’t have to open the artery just because you can open the artery,” said Dr. Alexander, referring to inserting a stent. “We have to think about the whole person.”

Recent studies indicate that some frequently used medical approaches do not pay older patients, while too little uses one intervention.

Here are some of the researchers with elderly hearts:

Shock to the heart

Implaced Kardioverter or ICD defibrillator is a compact battery -powered device that is placed under the skin and provides a shock in the event of a sudden cardiac arrest. “It is effortless to sell these things to patients,” said Dr. Daniel Matlock, Geriatric and researcher at the University of Colorado. “You say,” It can prevent a sudden death of the heart. ” The patient says, “It sounds great.”

In 2005, An Influential examination He convinced Medicare to cover ICDS in patients with heart failure, even those without high -risk arrhythmia, and “this was started,” said Dr. Matlock.

According to the American College of Cardiology’s Registry American College of Cardiology, in 2015 until September 2024 they lined 585,000 such devices in patient boxes. This is probably a pillow, because not all hospitals participate in the register.

But in 2017, among patients with non -Ischemical heart failure (which means that the heart does not pump effectively, but there is no blocked artery), Another influential study They showed that ICD did not reduce mortality in patients over 70 years of age. The device prevented only sudden heart deaths, the authors noticed – and are more common in younger patients.

In addition, “at the age of 85 or 90, sudden death is not necessarily the worst thing that can happen,” said Dr. Matlock compared to death because of “progressive heart failure, which can go quickly or last for years; This is unpredictable. “Wallop ICD shock can also frighten and suffer older patients who are often not aware that the device can be deactivated with a computer.

Cardiologists and researchers still debate how much icds benefits to older patients. But because heart drugs have grown much more strongly since 2005, and Serious multi -university studies are underway To determine, among patients exposed to sudden death, whether the drugs themselves can now be more effective.

Invasive procedures

The drugs themselves seem to be at least equally effective in the treatment of the elderly who suffered heart attacks, which were not suddenly caused and completely blocked by the artery. (Technically they are referred to as NSTEMI, for a heart attack of non-st-stegegent.)

Half of them take place in people over 70 years of age, said Dr. Vijay Kunadian, professor of intervention cardiology at Newcastle University in England and the main author of recent research at the Up-to-date England Journal of Medicine.

“Older people are often insufficiently represented in research,” said Dr. Kunadian. “There are many prejudice prejudices.” So her team recruited a sample older than a typical (average age of 82), in which the benefits of conservative and invasive treatment can be compared.

Half of 1,500 patients in the study A scheme of heart drugs began, which included diluments of blood, statine, beta -blockers and ACE inhibitors. The second half had more invasive treatment, starting with angiogram (radiation of blood vessels). Then about half of this group received a stent or, in a much smaller number, underwent a bypass operation. These patients also prescribed the same types of drugs as patients treated with drugs themselves.

Over the past four years, the team did not find a difference in the risk of cardiovascular death of patients or a non -violent heart attack. Although the surgical risk is generally growing with age, the complications were low in both groups.

In the face of such situations, older patients and their families must ask vital questions, Dr. Alexander said: “How will it assist me and what are the other options, especially if it is invasive? Is it necessary? What if I don’t do it? “

Dr. Kunadian agreed. “One size does not match this group,” she said. Invasive treatment did not benefit patients, but also did not hurt them.

Despite this, Dr. Kunadian said: “If they are very breakable, they live in a care home with dementia, with many other conditions, it is reasonable to say that their best interest is to apply medical therapy itself.”

Heart rehabilitation

One intervention, which is known to benefit patients with heart disease, is heart rehabilitation: a program of regular, supervised exercises, which significantly reduces heart attacks, hospitalization and cardiovascular deaths.

But cardiac rehabilitation has always been unused. Dr. Dodson said that only about a quarter of qualifying patients, and among older adults who could benefit even more, this percentage is still lower.

“There are there Barriers for people In the 70s and 80s – he said. They must appear in an exercise facility, so sometimes “transport is a problem.”

And he added: “People can be decadested or fear of activity. They may worry about a fall. “

NYU Langone’s personal program includes three exercise sessions a week for three months, with nutrition and psychological counseling. Because signing up among seniors was disappointed, scientists tried to recreate it remote program.

They offered this to patients (average age 71) with ischemic heart disease (caused by narrowed arteries that hinder blood and oxygen flow to the heart) who have suffered a heart attack or underwent a stent procedure. Everyone received a tablet computer and broadband access so that they can run a rehabilitation program at home. Exercise therapist registered on the phone every week.

Over time, participation at home fell over time. After three months, people assigned to distant rehabilitation did not show much functional ability – measured how far they can go in six minutes – than a similar group that observed ordinary care.

Is it because seniors struggled with technology? Or are you afraid of exercising with heart problems? Would the exercise personally, along with others on the treadmill and elliptical trainers, inspire greater commitment?

“We need to determine the most effective delivery system,” said Dr. Dodson. “What is the most motivating for older patients?” He will try again.