Newspaper article St Louis Post-Dispatch (MO)

Heart Matters: Mild Attacks Called Treatment Risk for Elderly

Newspaper article St Louis Post-Dispatch (MO)

Heart Matters: Mild Attacks Called Treatment Risk for Elderly

Article excerpt

If you're one of the 400,000 elderly Americans expected to suffer a heart attack this year, chances are good that if the attack is a small one, doctors won't do all they could for you.

And that could be costly down the line.

A study by researchers at Washington University School of Medicine shows that people over 70 who survive relatively small heart attacks are more likely to die in the year after they are discharged from the hospital than younger people with similar attacks or older people with larger attacks.

The finding negates the popular misconception that small heart attacks are less serious than larger ones, said Dr. Michael W. Rich, an associate professor of medicine.

Rich, who is also director of geriatric cardiology at Jewish Hospital, said the study shows that the younger people and the older people with larger attacks get more aggressive treatment from doctors. The study was published in a recent edition of the American Journal of Cardiology.

"People tend to have a false sense of security about smaller heart attacks because these patients have a more favorable outcome early on," said Rich, the study's lead investigator. "But they really aren't less serious because so many of these patients still do poorly after they go home."

He says doctors are reluctant to run out "big gun" therapies such as angioplasty and clot-busting drugs for patients suffering smaller heart attacks.

Rich cited three reasons:

Age-related risk for complications from such procedures.

Older people's lower expectations about their post-discharge activity levels.

Older people's unwillingness to submit to aggressive medical treatment.

"Procedures like heart catheterization and angioplasty require informed consent," Rich said. "Physicians can explain the rationale for these procedures, but a hospital is not a jail. We can't force people to undergo treatments they don't want."

Rich's team studied 70 patients over age 70 who were hospitalized after suffering smaller myocardial infarctions. They were followed for a year, and their death rate was compared with 61 patients who were under 70 and had suffered similar milder attacks and 56 patients over 70 who had suffered larger attacks. …

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