It turns out that the Isley brothers, who sang that in 1966 motown hit “this old heart (it is weak for you)”, was in something when they associate age with a pain and flag heart.
Heart illnesses, the leading cause of the death and disability of the nation, has been diagnosed in about 6 % of Americans aged 45 to 64 years, but in over 18 % of people over 65, according to Disease Control and Prevention Centers.
Old hearts are normally different. “The heart gets tougher as we grow older,” said Dr. John Dodson, director of the Nyu Langone Health. “It is not filled with blood so easily. Muscles do not relax as well.”
Age also changes the blood vessels, which can grow rigidly and cause hypertension and nerve fibers that send electrical impulses to the heart. It affects other organs and systems that play a role in cardiovascular health. “After the age of 75 is when things get accelerated,” Dr. Dodson said.
But in recent years, dramatic improvements in treatments for many types of cardiovascular states have helped to reduce both heart attacks and heart deaths.
“Cardiology has been blessed with great progress and development of research and drugs,” said Dr. Karen Alexander, who teaches Geriatric Cardiology at Duke University. “Medicines are better than ever, and we know how to use them better.”
This can complicate decision -making for heart patients in the 1970s, however. Some procedures or shapes may not significantly extend the lives of elderly patients or improve the quality of the rest of their years, especially if they have already suffered heart attacks and question other diseases.
“We do not need to open an artery simply because there is an artery that will open,” Dr. Alexander said, referring to the introduction of a stent. “We need to think of the whole person.”
Recent research shows that some often used medical approaches do not exude elderly patients, and very few of them take advantage of an intervention.
Here are some of the researchers learn about old hearts:
A shock to the heart
An implanted defibrillator or ICD is a small device powered by a battery placed under the skin and offers a shock in the case of sudden cardiac arrest. “It’s easy to sell these things to patients,” said Dr. Daniel Matlock, a geriatric and researcher at the University of Colorado. “You say,” this can prevent sudden heart death. “The patient says,” This sounds great. “
In 2005, a study of study convinced Medicare to cover ICD in patients with heart failure, even those without high -risk arrhythmias, and “just took off”, Dr. Matlock said.
From 2015 to September 2024, surgeons implanted 585,000 such devices in patients’ breasts, according to the register of the American College of Cardiology. This is probably underwater, as not all hospitals in the register participate.
But in 2017, among patients with non -ischemic heart failure (which means that the heart does not effectively derive, but there is no blocked artery), another study of study showed that ICD did not reduce mortality for patients above 70., Authors They have noted – and they are more common in younger patients.
In addition, “in 85 or 90, sudden death is not necessarily the worst thing that can happen,” Dr. Matlock said, compared to death from “progressive heart failure, which may go quickly or last for years.
Cardiologists and researchers are still discussing how many ICD benefits from elderly patients. But because heart drugs have increased the more powerful since 2005, an important multi -element study is underway to determine, among patients at a lower risk of sudden death, if the drugs could only now be more effective.
Penetrating procedures
Only drugs seem to be at least as effective in the treatment of the elderly who have suffered the type of heart attacks that are not caused by a sudden and completely blocked artery. (Technically these are referred to as NSTEMI, for the infarction of myocardial non-section lifting.)
Half of them happen to people over 70, said Dr. Vijay Kunadian, Professor of Invasive Cardiology at Newcastle University in England, and the main author of a recent study in the New England Journal of Medicine.
“Elderly people are often under -sought -over in research,” Dr. Kunadian said. “There are many prejudices.” Thus, her team recruited a sample of older than the typical (average age of 82 years) to compare the benefits of conservative and invasive treatment.
Half of the 1,500 patients in the study began a shape of heart drugs that included diluted blood, statins, beta inhibitors and ACE inhibitors. The other half had more invasive treatment, starting with a angiography (radiography of blood vessels). Then, about half of this group received a stent or, in much smaller numbers, underwent bypass surgery. These patients had also been prescribed the same species of drugs as patients who were treated only with medication.
For over four years, the group has not found a difference in the risk of cardiovascular deaths of patients or in non -deadly heart attack. Although surgical risks generally increase with age, complications were low in both groups.
Taking such situations, older patients and their families have to ask important questions, Dr. Alexander said: “How will this help me and what are the other options, especially if they are penetrating? Is it necessary? What if I do not do this ; ”
Dr. Kunadian agreed. “A size does not suit everyone in this group,” he said. Invasive treatment did not benefit patients, but did not hurt them.
Still, Dr. Kunadian said: “If they are very weak, living in a nursing home with dementia, with several other conditions, it is reasonable to say that it is in their interest to only use medical treatment.”
Cardiac recovery
An intervention known to benefit patients with heart disease is cardiac rehabilitation: a regular, supervised exercise program that significantly reduces heart attacks, hospitalization and cardiovascular deaths.
But cardiac detoxification remains eternal undervalued. Only about a quarter of eligible patients are involved, Dr. Dodson said, and among older adults, who could benefit even further, the rate is even lower.
“There are obstacles for people in the 1970s and 80s,” he said. They need to appear in an installation for exercise, so sometimes “transport is a problem”.
And, he added, “people can deny or fear the activity. They may worry about falling.”
The NYU Langone personal program includes three exercise sessions a week for three months, with nutrition and psychological counseling. Since the registration between the elderly was frustrating, the researchers tried to reproduce it with a remote program.
They offered it to patients (average age 71 years) with ischemic heart disease (caused by narrow arteries, which prevent the flow of blood and oxygen to the heart) that had suffered a heart attack or undergoing a stent process. Everyone received a tablet computer and a broadband access so that they could undertake a home rehabilitation program. An exercise therapist checked over the phone weekly.
However, participation in the house fell over time. After three months, those assigned to remote rehabilitation did not show greater operational capacity – measured from how far they could walk in six minutes – by a similar group that followed the usual care.
Was that because the elderly fought with technology? Or are they afraid of exercise with heart problems? Will it personally work out, along with others in corridors and elliptical trainers, inspiring more commitment?
“We need to calculate the delivery system that is more effective,” Dr. Dodson said. “What is the most motivation for older patients?” Will try again.
