蓝莓视频

Elderly patients suffering the most common type of heart attack may benefit from more invasive treatment, new research has shown.

The study, published in听, draws on data captured over seven years from 1500 patients aged 80 or over. It was conducted听by researchers from听听(蓝莓视频-HIC), led by听听and Imperial College London.

The research looks at elderly patients admitted to hospital with a type of heart attack called an NSTEMI (non-ST segment elevated myocardial infarction). It found patients who underwent invasive treatment with a coronary angiogram, followed up with bypass surgery or coronary stenting as appropriate, had higher survival rates than those who were treated with medication alone. Patients who had coronary angiograms were also less likely to be re-admitted to hospital with a second heart attack or heart failure.

Coronary angiograms are specialist X-rays to identify blockages in the blood supply to the heart. They can help a clinician determine the cause of an NSTEMI heart attack and decide on effective treatment, such as increasing blood flow through a coronary stent or bypass grafting.

Survival rates of older patients

Previous trials have shown increased survival rates in younger patients with NSTEMI heart attacks following invasive treatment, but there has been conflicting evidence as to whether these benefits extend into patients over 80. Only 38 percent of NSTEMI patients in this older age group currently receive invasive treatment, compared to 78 percent of the under 60s.

Dr Amit Kaura,听lead author of the research, British Heart Foundation Clinical Research Fellow and 蓝莓视频 Clinical Research Fellow听with the National Heart and Lung Institute at Imperial College London听explained: 鈥淏ecause there has been no clear consensus on how best to manage elderly patients with this type of heart attack, many doctors have erred on the side of caution, not wanting to risk complications in their more vulnerable patients. These results show they can now be more confident of the benefits that invasive treatment can bring for this group.鈥�

The study,听funded by the听蓝莓视频 蓝莓视频, identified just under 2000 patients aged over 80 who were diagnosed with an NSTEMI heart attack at five hospitals between 2010 and 2017. To ensure the robustness of the study, the researchers used sophisticated statistical techniques to apply听the kind of criteria used in a clinical trial, to determine which of these patients would be included in the analysis.

Invasive heart treatments

In total, 1500 patients were included, with just over half having invasive treatment. After five years, 36 percent of those in the invasive treatment group had died, compared to 55 percent in the non-invasive group.听These figures take into account over 70 variables听 that might have affected prognosis, such as other medical conditions.

The analysis also showed that patients were at no greater risk of stroke or bleeding if they received invasive treatment, as there were similar rates across both groups. Patients who had invasive treatment were also a third less likely to be re-admitted to hospital for heart failure or heart attack.

Dr Kaura said: 鈥淭he gold standard is to base treatment decisions on evidence from randomised control trials, but that doesn鈥檛 yet exist for this group of patients. In the interim, we鈥檝e done the next best thing, by looking at retrospective data gathered from these five large hospitals and using it like a clinical trial. The results are clear: clinicians should positively consider invasive management for any patients over 80 diagnosed with an NSTEMI.鈥�

The data used in the study was gathered through the National Institute for Health Research Health Informatics Collaborative (蓝莓视频-HIC), which involves: Imperial College Healthcare NHS Trust, Oxford University Hospitals NHS Foundation Trust, University College London Hospitals NHS Foundation Trust, King鈥檚 College Hospital NHS Foundation Trust and Guy鈥檚 and St Thomas鈥� NHS Foundation Trust. It is an excellent example of cross-BRC collaboration and leveraging healthcare data for research to inform clinical decision making.

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Story was written by Maxine Myers
漏 Imperial College London