It turns out that the Isley brothers, who sang that 1966 Motown hiring “This old heart of mine (he is weak for you)”, they were on something when they connected to a sore and reported heart.
Cardiac diseases, the main cause of death and disability of the nation, was diagnosed in about 6 % of Americans aged between 45 and 64, but in over 18 percent of those over 65, according to the control centers and the prevention of diseases.
Old hearts are physiologically different. “The heart becomes more rigid with age,” said dr. John Dodson, director of the Geriatric Cardiology program at the Nyu Langone Health. “It is not filled with blood so easily. Even the muscles do not relax. “
Age also changes the blood vessels, which can grow rigid and cause hypertension, and the nerve fibers that send electrical impulses to the heart. It also affects other organs and systems that play a role in cardiovascular health. “After the age of 75, it is when things accelerate,” said dr. Dodson.
But in recent years, dramatic improvements in treatments for many types of cardiovascular conditions have contributed to reducing both heart attacks and cardiac death.
“Cardiology was blessed with many progress, research and development of drugs,” said dr. Karen Alexander, who teaches Geriatric cardiology at Duke University. “The drugs are better than ever and we know how to use them better.”
This can complicate the decision -making process for heart patients in their 70s and beyond, however. Some procedures or regimes may not significantly extend the life of older patients or improve the quality of their remaining years, especially if they have already suffered heart attacks and also support other diseases.
“We don’t need to open an artery just because there is an artery to open,” said dr. Alexander, referring to the insertion of a stent. “We have to think about the whole person.”
Recent searches indicate that some medical approaches used frequently do not pay for older patients, while too few of them exploit an intervention that does it.
Here are some of what the researchers are learning the old hearts:
A shock for the heart
An implantable cardboover defibrillator, or ICD, is a small battery device that is positioned under the skin and offers a shock in the case of a sudden cardiac arrest. “It’s easy to sell these things to patients,” said dr. Daniel Matlock, geriatrician and researcher from the University of Colorado. “You say:” This can prevent sudden heart death. “The patient says:” It seems fantastic “.
In 2005, an influential study persuaded to cover ICD in patients with heart failure, even those without high -risk arrhythmias and “It Just Just Decollated,” said dr. Matlock.
From 2015 to September 2024, surgeons have implanted 585,000 these devices in patients’s breasts, according to the American College of Cardiology register. This is probably a subtitle, since not all hospitals participate in the register.
But in 2017, among patients with non -ischemic heart failure (which means that the heart is not pumping effective, the authors have noticed – and those occur more frequently in younger patients.
Furthermore, “at 85 or 90, sudden death is not necessarily the worst thing that can happen,” said dr. Matlock, compared to the death of “progressive heart failure, which can go rapidly or last for years; it is unpredictable.” The wallop of an ICD shock can also frighten and anguish the older patients, who are often not aware that the device can be deactivated with a computer.
Cardiologists and researchers still discuss how much the ICD benefits the oldest patients. But since heart drugs have grown much more powerful since 2005, an important multi -exit study is underway to determine, among patients with low risk of sudden death, if only drugs could now be more effective.
Invasive procedures
The drugs alone seem to be at least equally effective in the treatment of elderly people who have undergone the type of heart attacks not caused by a suddenly and completely blocked artery. (Technically these are indicated as NSTEMI, for the myocardial infarction of non -segment elevation.)
Half of these occur in people over the age of 70, said dr. Vijay Kunadian, professor of interventional cardiology at Newcastle University in England and main author of a recent study on the New England Journal of Medicine.
“The elderly are often underneathing research,” said dr. Kunadian. “There are many preconceived prejudices.” So his team recruited an older sample than the typical (average age 82) in which to compare the benefits of conservative and invasive treatment.
Half of the 1,500 patients in the study began a cardiac drug regime that included blood fluids, statins, beta -bloccanti and ace inhibitors. The other half had a more invasive treatment, starting from an angiogram (a radius x of the blood vessels). So about half of that group received a stent or, in much smaller numbers, was subjected to bypass surgery. These patients were also prescribed the same types of patients who have been treated with drugs.
For four years, the team has not found any difference in the risk of cardiovascular death or a non -fatal heart attack. Although surgical risks generally increase with age, complications were low in both groups.
Face these situations, the oldest patients and their families must ask important questions, dr. Alexander said: “How will this help me and what are the other options, especially if it is invasive? Is it necessary? What if I don’t do it? “
Dr. Kunadian agreed. “A size does not adapt to everything in this group,” he said. The invasive treatment did not benefit from patients, but it hasn’t even damaged them.
However, dr. Kunadian said: “If they are very fragile, they live in a nursing home with dementia, with a number of other conditions, it is reasonable to say that it is in their interest to use medical therapy alone”.
Cardiac rehabilitation
An intervention known for the benefit of patients with heart disease is cardiac rehabilitation: a regular and supervised exercise program that significantly reduces heart attacks, hospitalization and cardiovascular deaths.
But cardiac rehabilitation remains perpetually underutilized. Only about a quarter of the eligible patients participate, said dr. Dodson, and among the oldest adults, who could benefit even more, the proportion is even lower.
“There are barriers for people in the 70s and 80s,” he said. They must present themselves in a structure to carry out, so sometimes “transport is a problem”.
And, he added, “people can be deconditated or fear of the activity. They may worry about falling. “
The Lagone della Nyu program in person includes three training sessions per week for three months, with nutritional and psychological advice. Since the registration between the elderly was disappointing, the researchers tried to replicate it with a remote program.
They offered it to patients (average age 711) with ischemic heart disease (caused by restricted arteries, which prevent the flow of blood and oxygen in the heart) which had suffered a heart attack or have undergone a stent procedure. Each has received a tablet and broadband access so that we can undertake a rehabilitation program at home. A physical exercise therapist who checked -in by phone weekly.
Participation at home has fallen over time, however. After three months, those assigned to remote rehabilitation did not show a greater functional capacity – measured by what could walk in six minutes – compared to a similar group that followed the usual treatments.
Was it because the elderly have fought with technology? Or fear the exercise with heart problems? Training in person, together with others on treadmills and elliptical instructors, would it inspire greater involvement?
“We have to understand the most effective delivery system,” said dr. Dodson. “What’s more motivating for older patients?” He will try again.