Patients older than 75 years have improvements in symptom relief and quality of life after coronary bypass surgery comparable with those obtained with younger patients, according to an article in the October 15th issue of the Journal of the American College of Cardiology.

The American researchers studied 690 consecutive patients who underwent bypass
surgery at one heart institute, 156 of whom were older than 75 years. At the time of surgery, each participant was given a questionnaire for patients with coronary artery disease. A second questionnaire was given a year after surgery. In addition, some patients were given monthly questionnaires for the first 6 months following surgery.

Although older patients recovered physical function more slowly than younger patients, their average scores were similar a year after the bypass surgery. Angina relief and quality of life improvements did not differ by age, with both groups reporting benefits soon after their operations.

Perioperative mortality rates were less than 3 percent in both groups. A higher percentage of older patients died within a year of surgery (11.5% versus 5.4%), but the researchers said that the result did not necessarily reflect poor outcomes because the population of older patients was expected to have a higher death rate over time.

John A. Spertus, MD, MPH, lead author, said that the current study helps fill in gaps left by earlier studies that focused on survival statistics. "There are two reasons we do these procedures: one is to make patients live longer, and the second is to make them feel better. It's the 'feeling better' part that we quantified in this particular study. There hasn't been a lot of data on that, and yet to patients, that's really the most important thing. Often patients come in because they want to feel better, to alleviate the symptoms and the functional limitations and the impairment of the quality of their lives." Spertus hopes the results encourage clinicians to be more confident about recommending bypass surgery for patients who seem to be good candidates even though they are elderly.

The researchers did report higher complication rates among older patients and some other problems, including a higher rate of strokes, but these events did not offset the quality of life gains observed over a year of follow-up.

Because the study observed outcomes of patients who had already been selected as good candidates for bypass surgery, it did not address potential factors in the selection process. In addition, because the study enrolled only patients who had been referred to surgery, it is not a comparison of bypass surgery versus other treatments.

In an editorial, Mathew S. Maurer, MD, wrote that the study provides further insights into the role of bypass surgery in elderly patients. He noted that quality of life following bypass surgery has become a major issue and that decisions about treatment options go beyond merely calculating survival odds.

"Future investigations should continue to challenge our bias against treating the elderly, demanding rigorous investigation into the factors that impair quality and quantity of life for the elderly patient with cardiovascular disease," Maurer wrote.

Lawrence Cohn, MD, said results like those seen in this study should be well-known, but apparently are not: "I think it is an important article, therefore, particularly for geriatricians and cardiologists, so they realize that in the properly selected cases, no matter how old the patient is, a coronary bypass can be effective."