New insights into older hearts

It turned out that the Isley Brothers who met this 1966 Motown “This Old Heart of Mine (for them weak) were on something when they connected age with a painful and marking heart.

Heart diseases, the most common cause of death and disability in the country, was diagnosed in about 6 percent of the Americans aged 45 to 64, but in more than 18 percent of the over 65 years according to the centers for the control and prevention of diseases.

Old hearts are physiologically different. “The heart becomes stiff with increasing age,” said Dr. John Dodson, director of geriatric cardiology program at the Nyu Langone Health. “It doesn't fill up with blood so easily. The muscles don't relax either. “

The age also changes the blood vessels that become rigid and can cause high blood pressure, and the nerve fibers that send electrical impulses to the heart. It also affects other organs and systems that also play a role in cardiovascular health. “After the age of 75, things accelerate,” said Dr. Dodson.

In recent years, dramatic improvements to the treatments for many types of cardiovascular diseases have contributed to reducing both heart attacks and heart death.

“Cardiology was blessed with a lot of progress, research and drug development,” said Dr. Karen Alexander, who teaches geriatric cardiology at Duke University. “The medication is better than ever and we know how we can use them better.”

However, this can complicate decision -making for cardiac patients in the 70s and beyond. Certain procedures or regimes may not significantly expand the lives of older patients or improve the quality of their remaining years, especially if they have already suffered heart attacks and also fight with other diseases.

“We don't have to open an artery just because an artery has to be opened,” said Dr. Alexander and referred to the insertion of a stent. “We have to think of the whole person.”

Recent studies show that some frequently used medical approaches do not pay out for older patients, while too few of them use an intervention that does this.

Here you will find some of the researchers about old hearts:

A shock for the heart

An implantable cardioverter defibrillator or ICD is a small battery-operated device that is placed under the skin and delivers a shock when the cardiac arrest suddenly provides a shock. “It's easy to sell these things to patients,” said Dr. Daniel Matlock, geriatric and researcher at the University of Colorado. “They say:” This can prevent a sudden heart. “The patient says:” That sounds great. “

In 2005, an influential study by Medicare persuaded me to cover ICDs in patients with heart failure, even in patients without high-risk arrhythmias, and “just started,” said Dr. Matlock.

From 2015 to September 2024, surgeons implanted 585,000 such devices into the patient's chest, according to the American College of Cardiology. This is probably an underpayment because not all hospitals take part in the registration.

In 2017, another influential study showed patients with non -ischemic heart failure (which means that the heart does not pump effectively but no blocked artery), the authors found – and these occur more often in younger patients.

In addition, “with 85 or 90, sudden death is not necessarily the worst that can happen,” said Dr. Matlock compared to death through “progressive heart failure”, which can take quickly or for years. It is unpredictable. “The Wallop of an ICD shock can also scare and worry older patients, who often do not know that the device can be deactivated with a computer.

Cardiologists and researchers still discuss how many icds of older patients benefit. However, since cardiac medication has become so much more effective since 2005, an important study with several multisites is underway to determine in patients with less risk of sudden death whether medication alone may be more effective.

Invasive procedure

Medicines alone seem to be at least as effective in the treatment of older people who have suffered the kind of heart attacks that were not caused by a sudden and fully blocked artery. (Technically speaking, these are referred to as NSTENI for non-segment myocardial infarction.)

Half of it takes place in humans over 70 people, said Dr. Vijay Kunadian, professor of interventional cardiology at Newcastle University in England and the leading author of a recently in the New England Journal of Medicine.

“Older people are often underrepresented in research,” said Dr. Kunadian. “There are many prejudices.” Your team recruited an older typical sample (average age 82), in which the advantages of conservative and invasive treatment can be compared.

Half of the 1,500 patients in the study began a regime of cardiac medication, which included blood thinners, statins, beta blockers and ACE inhibitors. The other half had an invasive treatment, starting with an angiogram (an X -rays of the blood vessels). Then about half of this group received a stent or was operated on in much smaller numbers. These patients were also prescribed the same types of medication as the patients treated with medication.

The team found no difference in the risk of patients for cardiovascular death or a non -fatal heart attack for over four years. Although the surgical risks generally increase with age, the complications in both groups were low.

In view of such situations, older patients and their families have to ask important questions, Dr. Alexander said: “How will that help me and what other options are the other options, especially if it is invasive? Is it necessary? What if I don't do that? “

Dr. Kunadian agreed. “A size doesn't fit into this group,” she said. The invasive treatment did not benefit from patients, but it did not harm them either.

Nevertheless, Dr. Kunadian: “If you are very frail and live in a nursing home with dementia with a number of other diseases, it is reasonable to say that it is in your best interest to use medical therapy alone.”

Cardiac rehabilitation

An intervention in which patients with heart diseases benefit is the heart rehabilitation: a program of regular, monitored movement, which significantly reduces heart attacks, hospital stays and cardiovascular deaths.

But the cardiac rehab is not used again and again. Only about a quarter of legitimate patients participate, said Dr. Dodson, and among older adults who could benefit even more of it, the proportion is still lower.

“There are obstacles for people in the 70s and 80s,” he said. You have to appear in a facility to train, so “transport is a problem”.

And he added: “People can be determined or are afraid of activity. You can worry that you fall. “

The personal NYU Langone program comprises three exercise sessions per week with nutrition and psychological advice for three months. Since the enrollment among seniors, the researchers have tried to replicate it with a remote program.

They offered patients (average age 71) with ischemic heart disease (caused by narrowed arteries who hinder blood and oxygen flow to the heart) who had suffered a heart attack or subjected a stent procedure. Everyone received a tablet computer and broadband access so that they could carry out a rehab program at home. A training therapist who checked by phone every week.

However, participation at home dropped over time. After three months, those who were assigned to the remote rehab showed no greater functional capacity – measured by how far they could run in six minutes – as a similar group that followed the usual care.

Was that because seniors had to struggle with the technology? Or fears to train with heart problems? Would personal training be inspired by others on treadmills and elliptical instructors?

“We have to find out the most effective delivery system,” said Dr. Dodson. “What motivates the most for older patients?” He will try again.