Being in your late 70s or 80s does not automatically mean you are too old for a common heart procedure, according to new research led by Yale University.
The study suggests that a person’s overall health may tell doctors more than the number of birthdays they have had.
The research focused on percutaneous coronary intervention, usually called PCI. During this procedure, doctors guide a thin tube through a blood vessel and often place a small mesh tube called a stent inside a narrowed heart artery to help keep blood flowing.
PCI is widely used in people with coronary artery disease. This disease develops when fatty material and other substances build up inside arteries that supply the heart, narrowing the space available for blood to pass through.
When coronary disease is chronic, it develops and persists over time rather than appearing suddenly as an emergency heart attack. People may experience chest discomfort, shortness of breath or limits on physical activity, although symptoms vary considerably.
Coronary disease becomes more common as people age, which makes treatment decisions particularly important for older adults. Yet people in older age groups have often been excluded or underrepresented in clinical trials of heart procedures.
That leaves doctors with an important question: how much should age itself influence the decision to perform PCI? The Yale-led study tried to provide a clearer answer using information from everyday medical practice.
The researchers examined data from more than 176,000 adults who underwent PCI for chronic coronary disease between January 2016 and June 2022. Almost three in every 10 patients were aged 75 or older.
The findings were published in the Journal of the American Geriatrics Society. Dr. Zafer Akman of the Yale Department of Internal Medicine was the study’s first author, and Dr. Michael Nanna was the senior author.
When researchers first looked at the data, older patients seemed more likely to experience complications. That was not surprising because older people in the study also tended to enter the procedure with more medical problems.
Age often comes with conditions such as kidney disease, diabetes, previous heart problems and other illnesses that can affect the risks of treatment. This makes it difficult to know whether poorer outcomes are caused by age itself or by the health problems that are more common with age.
To address this, the researchers compared older and younger patients who had similar health backgrounds. Once these differences were taken into account, the picture changed substantially.
Adults aged 75 and older had outcomes that were broadly similar to those of younger patients. Their adjusted risk of death and major bleeding was similar, while their risk of major harmful cardiovascular events was actually slightly lower.
That surprising result does not mean growing older somehow protects the heart. The researchers believe it probably reflects the careful way doctors select older patients for an invasive procedure.
An older adult who is very frail or has several serious illnesses may never be offered PCI. As a result, the older people who actually receive the procedure may represent a healthier and more carefully selected group than older adults with coronary disease as a whole.
There was one important difference. Older patients had about a 40% higher risk of being admitted to hospital for a heart-related reason during the following year.
The study therefore does not suggest that PCI is equally appropriate for every older person. Instead, it challenges the idea that chronological age should be used by itself to decide whether someone is a suitable candidate.
Two people who are close in age can have very different levels of health. An independent 80-year-old who remains active and continues to have troubling symptoms despite medication may have a very different treatment outlook from a frail person in their early 70s with several serious illnesses.
Frailty is particularly important because it describes reduced physical reserve and a lower ability to recover from illness or medical procedures. Doctors may also need to consider kidney function, other diseases, mobility and a patient’s ability to manage daily activities independently.
The researchers acknowledged that their study could not fully capture several issues that matter greatly in later life. These included memory and thinking ability, physical function, social support, symptom burden and quality of life.
Those factors can change what a successful treatment means. For some older adults, extending life may be the highest priority, while others may care most about remaining independent, reducing chest pain or continuing activities that are important to them.
The study is valuable because of its very large real-world population, but it is observational rather than a randomized clinical trial. That means it can identify patterns and associations, but it cannot prove that PCI itself produces the same benefits in healthy older and younger adults.
Selection is also a major issue when interpreting the results. Because doctors may already be choosing relatively healthy older adults for PCI, the findings should not be used to assume that every person over 75 would have similarly favorable outcomes.
Overall, the research supports a more individual approach to heart care in later life. Age still matters, but health, frailty, independence, other illnesses, symptoms and personal goals may provide a much fuller picture when deciding whether PCI is worthwhile.
The strongest message is that a birth date should not automatically close the door on treatment. For older adults with chronic coronary disease, the better question may be not simply “How old is this patient?” but “How healthy is this person, what are they hoping to achieve, and is this procedure likely to help them get there?”
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Source: Yale University.
