The Eilee Brothers, who sang “My Old Heart (With You)” in 1966 as a hit, was that when they tied their age to a heart that was painful and flagged, something was in it. got it.
Heart disease, the country's leading cause of death and disability, is diagnosed in about 6% of Americans aged 45 to 64, but according to the Centers for Disease Control and Prevention, more than 18% of people over 65 are diagnosed. It has been diagnosed.
Older minds are physiologically different. “The geriatric cardiology program at Nyu Langone Health,” said Dr. John Dodson, director of the Geriatric Cardiology Program. “It's not easily filled with blood. It doesn't relax the muscles either.”
Age also changes blood vessels. Blood vessels change blood vessels that can stiffen and cause hypertension, and also alter nerve fibers that send electrical impulses to the heart. It also affects other organs and systems that play a role in cardiovascular health. “After age 75, it's time for things to accelerate,” Dr. Dodson said.
However, in recent years, dramatic improvements in the treatment of many types of cardiovascular symptoms have helped to reduce both heart attacks and heart death.
“Heart disease is blessed with a lot of advances, research and drug development,” says Dr. Karen Alexander, a geriatric cardiology teacher at Duke University. “Drugs are better than ever and we know how to use them better.”
However, it can complicate decision-making for cardiac patients since the 1970s. Certain procedures or regimens can significantly prolong the lives of older patients or improve the quality of the rest of the year, especially if they have already had a heart attack and are fighting other illnesses. there is no.
“Just because the artery is open, there's no need to open it,” Dr. Alexander said, referring to the insertion of the stent. “We need to think about the whole person.”
Recent studies have shown that frequently used medical approaches are not rewarding for older patients, but too few people use one intervention.
This is part of what researchers are learning about the old mind:
A shock to the heart
An implantable defibrillator, or ICD, is a small, battery-powered device that is placed under the skin and impacts in the event of sudden cardiac arrest. “We've seen a lot of people and people who are exploited,” said Daniel Matlock, an elderly and researcher at the University of Colorado. “You say, 'This can prevent sudden cardiac death.' The patient says, “It sounds great.” ”
In 2005, an influential study convinced Medicare to cover ICDs in patients with heart failure, even those without high-risk arrhythmia, and “just took off,” Dr. Matlock said.
From 2015 to September 2024, the surgeon implanted 585,000 such devices into the patient's chest, according to the American Cardiology Registry. That's probably a shortage, as not all hospitals are involved in the registry.
However, in 2017, in patients with non-ischemic heart failure (which means that the heart is not pumped effectively but does not block arterial blockage), another influential study found that ICD was 70. It was shown to not reduce the mortality rate in patients exceeding the rate. , the authors pointed out – and they occur more frequently in younger patients.
Furthermore, “A sudden death at age 85 or 90 is not necessarily the worst possible situation,” Dr. Matt Rock said, “compared to death from progressive heart failure. It's unpredictable.” ICD Shock wallops can scare and torment older patients who don't know that their devices can be deactivated on a computer.
Cardiologists and researchers still debate how much ICD benefits older patients. However, since 2005, cardiac drugs have become much more potent, leading to a major multisite study to determine whether drugs alone are more effective among patients at a lower risk of sudden death. is underway.
Invasive Procedures
Drugs alone seem to be at least equally effective in treating elderly people suffering from heart attacks where sudden arteries do not suddenly develop. (Technically, these are called NSTEMI in the case of non-ST segment elevation myocardial infarction.)
Half of these occur in more than 70 people, Vijay Kunadien, professor of interventional cardiology at Newcastle University in the UK and lead author of a recent study in the New England Journal of Medicine. The doctor said.
“Elderly people are often underestimated in research,” Dr. Cunadian said. “There are a lot of preconceptions.” So, her team recruited a typical sample (average 82 years old) over the older ones to compare the benefits of conservative and invasive treatments.
Half of the 1,500 patients in this study began regimens for cardiac medications that contain thin blood, statins, beta blockers, and ACE inhibitors. The other half received more invasive treatment starting with angiography (X-rays of blood vessels). About half of the group then received stents or a much smaller number of them underwent bypass surgery. These patients were prescribed the same type of medication as patients treated with medication alone.
For more than four years, the team found no difference in the risk of a patient's cardiovascular death or non-fatal heart attack. Surgical risk generally increases with age, but complications were lower in both groups.
In the face of such a situation, older patients and their families need to ask important questions, Dr. Alexander said: Is it necessary? What happens if you don't do this? ”
Dr. Kunadian agreed. “Not all one size fits this group,” she said. Invasion treatment did not benefit patients, but also did not harm patients.
Still, Dr. Cnadian said, “If they are very frail and live in a nursing home with dementia, if there are many other conditions, then using medical therapy alone is the greatest benefit. That's reasonable.”
Cardiac rehabilitation
One intervention known to benefit patients with heart disease is cardiac rehabilitation. It is a regular, supervised exercise program that significantly reduces heart attacks, hospitalizations and cardiovascular deaths.
However, cardiac rehabilitation is not permanently used. Only about a quarter of eligible patients participate, Dodson said that the proportion is still low among older adults who can earn even more benefits.
“There are barriers for people in the 70s and 80s,” he said. Sometimes “transportation is the problem” because they have to show up at facilities to exercise.
And he added: They may be worried about falling. ”
The in-person NYU Langone program includes three exercise sessions per week for three months, with nutrition and psychological counseling. The registration of the elderly was disappointing, so the researchers tried to replicate it in a remote program.
They provide it to patients (average age 71) with a heart attack or stented-treated ischemic heart disease (caused by stenosis arteries and obstructing blood and oxygen flow to the heart) did. Each received tablet computers and broadband access, allowing them to perform rehabilitation programs at home. An exercise therapist who checks in on the phone every week.
However, attendance at home declined over time. Three months later, those assigned to remote rehabilitation showed no greater functional ability, measured by how far they could walk in 6 minutes, than similar groups following normal care.
Was that because older people were struggling with this technology? Or are you afraid to exercise due to heart problems? Would exercise directly with others on a treadmill or an oval trainer stimulate more engagement?
“We need to know which delivery systems are most effective,” Dr. Dodson said. “What is the most motivating for older patients?” he is trying again.
