Although patients age 80 or older with acute coronary syndromes tend to be sicker and twice as likely to die as patients in their 70s, interventions in selected very elderly patients are associated with 2-year outcomes similar to those of younger patients treated at the same center, according to a new study in the February 4^th issue of the Journal of the American College of Cardiology.

"In short, the study shows that by selecting suitable elderly patients that are likely to benefit from further investigation and treatment, worthwhile clinical improvement can be obtained even in the very elderly," said David A. Halon, MBChB.

The researchers followed 449 consecutive patients with acute coronary syndromes admitted to a single Medical Center. The study group included 251 patients age 70 to 79 years and 198 patients age 80 years or older.

The very elderly patients (80 years or older) were sicker, more likely to have had a myocardial infarction or to have heart failure or kidney problems than patients in their 70s. Although clinicians were less likely to refer very elderly patients for angiography, the percentage of patients who eventually underwent angioplasty or bypass surgery was similar in both age groups.

Although very elderly patients were less likely to survive at least 2 years (67.4 percent versus 83.5 percent of patients in their 70s), the patients in their 80s who did survive were more likely to report improved well being.

"I think the bottom line is that there are important differences between elderly patients, and if patients are assessed individually for suitability for further investigation and possible intervention, then benefit may be achieved in a sizable proportion of even very elderly patients," Halon said.

The researchers said that part of the value of the current study was that it looked at typical patients in routine hospital practice rather than the carefully selected samples used in many trials involving elderly heart patients.

"The burden of coronary heart disease in the elderly is increasing rapidly in most or all Western countries and a similar picture to that described here would probably be found in many other hospital settings at the present time. However similar studies in other centers need to be done to confirm this," Halon said.

Christopher P. Cannon, MD, who was not involved in the research, said this study adds to evidence that clinicians should offer elderly patients the same sort of treatments they provide to similar, but younger, patients.

"In general there has been reluctance to treat the elderly, especially octogenarians, as aggressively as younger patients. Prior studies have found older patients receive less aggressive care. This study documents this very well for the octogenarians," Cannon said. "However, these older patients are at higher risk of adverse outcomes and death (as shown in this study) and thus would be good candidates for more aggressive care. Thus there has been a paradox-that the elderly are higher risk (where our guidelines would say be more aggressive) yet they receive less aggressive care. In this study, they found that patients treated more aggressively seemed to do better. Thus, this study suggests we need to be more aggressive with our elderly patients."