A life-changing look at heart and circulatory disease treatments for older peoplePosted on: 28 March 2018 by 50connect editorial
Keeping vital research going should help us to live not just longer but, crucially, healthier - improving quality, not just quantity, of life, writes Jane Collins.
As a nation we are living longer – but that increase in lifespan brings with it a potentially higher risk of developing conditions like diabetes, dementia and heart and circulatory disease. The good news is pioneering research and treatments mean more older people are surviving cardiac incidents (since the early 1960s deaths from cardiovascular disease have fallen by around half), the bad news is that figures from Public Health England reveal every month 7,400 people are still dying from heart disease or stroke (that’s around one death every three minutes) and three quarters of those are over 75. Heart and circulatory disease kills more than 1 in 4 people in the UK and now a timely new nationwide research project funded by the British Heart Foundation (BHF) is focusing specifically on whether treatments currently being prescribed for older people who have suffered a heart attack are the most appropriate ones.
Newer ways of looking at older patients
Dr Vijay Kunadian, Honorary Consultant Interventional Cardiologist at the Freeman Hospital in Newcastle, is heading up the research looking at how patients in their 70s, 80s and 90s are being assessed and treated. ‘People are surviving longer and this means heart disease is able to affect more people later in life who are more likely to have other conditions too,’ says Dr Kunadian adding she was increasingly seeing patients who were 85 or over and thinking, ‘There is very little research on how to help them as older people are often excluded from clinical research. It is important we identify how best to treat these patients to ensure they get the best care available and enhance their chances of survival.’
50% of heart attacks happen in patients aged 72 and over
Age appropriate treatment
One key concern is that as you hit 75 or over you are far less likely to receive tests like an angiogram – an X-ray procedure which pinpoints if, or where, your coronary arteries are blocked or narrowed - helping your doctor to give you the most appropriate treatment. In fact, the older you are the less likely you are to get one: UK figures suggest only around 14% of heart attack patients aged 85 or over have an angiogram compared to 83% of under 65s. Without it, procedures like angioplasty and stent or bypass surgery which re-direct blood flow to the heart, are unlikely to be carried out. Given that an angiogram is seen as something of a ‘gold standard’ in heart attack treatment why the reluctance to give it to older patients? The fear is that this generally safe and painless procedure is invasive - involving a long thin tube being inserted into the arm or groin which is passed through to the heart – and the risk of potential side effects increase in older, frailer patients. These can include bruising, soreness, bleeding under the skin where the tube was inserted, infection or trauma to blood vessels. Whether these potential risks outweigh the benefits is what Dr Kunadian and her colleagues are investigating.
Armed with £1.7m worth of funding raised by the BHF (the single biggest independent funder of heart and circulatory disease research in the UK), this nationwide investigation will focus on patients over 75 who have had the most common type of heart attack known as a non-STEMI or nSTEMI. Those taking part in the study will be divided randomly into two groups one receiving an angiogram followed by appropriate treatment whilst the other will be given appropriate heart medication. Both groups will be monitored over five years to see which has the better rates of survival and lower incidence of recurring cardiac problems.
Brian Thompson, an 84 year-old patient from Newcastle, who had a stent fitted after a heart attack in in June last year and has become part of this research project says, ‘I’m very lucky I’ve been able to carry on with my life with my wife. I hope that taking part in this trial will help doctors make better decisions for people like me’.
Keeping the research alive
Jeremy Pearson, Professor of Vascular Biology and Associate Medical Director at the BHF adds, ‘This trial marks a landmark study in improving care of older heart attack patients. A heart attack still has the power to devastate a person and their family and we need to keep funding research to find the breakthroughs that will make a difference.’ Keeping this vital research going should also help us to live not just longer but, crucially, healthier - improving quality, not just quantity, of life.
Celebrate your life by helping others
Legacy gifts come from ordinary people, and they are crucial to funding life saving research. It's so easy to leave a gift in your Will. By remembering the BHF in your Will with a share of what remains, after family and friends have been looked after, you can help create the next medical advances. What better way to thank the people and causes that have had an impact on your life, than to make a contribution through a gift in your Will?
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