Drug therapy as good as costly invasive cardiac procedures for elderly heart attack patients

A new study has found that drug therapy offers elderly heart attack patients as good a chance of long-term survival as receiving expensive, invasive, high-tech cardiac procedures, such as angiography, angioplasty and bypass surgery.

To investigate the impact of different types of cardiac management, researchers followed more than 158,000 elderly U.S. Medicare patients who were hospitalized with a heart attack in 1994 or 1995. U.S. regions were characterized according to the percentage of heart attack patients in the region who received invasive cardiac management and the percentage that received medical (drug) therapy. Patients were followed for up to seven years to see how the different cardiac management styles impacted long-term mortality.

The results showed that higher rates of drug therapy were associated with improved survival, regardless of invasive cardiac treatment. However, there was little or no improved survival benefit with invasive cardiac treatment in regions providing high rates of drug therapy.

“Our study has shown that routine provision of costly and invasive cardiac procedures doesn’t improve survival for elderly heart attack patients, provided they are appropriately prescribed cardiac medications. Provision of these invasive services appears to be related to the availability of cardiac technology rather than patient severity,” said lead author Dr. Thérèse Stukel, vice-president, research at the Institute for Clinical Evaluative Sciences (ICES).

“As well, our study has further confirmed that younger, healthier patients are more likely to receive invasive cardiac treatment, despite evidence demonstrating that older, higher-risk patients benefit more from such treatment.

“Going forward, we recommend a comprehensive, systems-minded approach to delivering evidence-based drug therapy to all appropriate heart attack patients. In addition, efforts should focus on providing invasive cardiac procedures only to those patients most likely to benefit,” said Dr. Stukel.

The study, “Long-term outcomes of regional variations in intensity of invasive vs. medical management of Medicare patients with acute myocardial infarction”, is in the Mar. 16, 2005 issue of the Journal of the American Medical Association (JAMA).

Author affiliations: ICES (Dr. Stukel); Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH (Dr. Stukel); Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto (Dr. Stukel); Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME (Drs. Lucas and Wennberg)

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

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