Guideline-guided medical therapy improves survival among the oldest heart attack patients

Guideline-guided medical therapy improves survival among the oldest heart attack patients

Researchers have found that prescribing medical treatment guidelines (GDMT), regardless of the number of medications, can improve survival rates in patients 90 years and older after their first heart attack, with the greatest benefits observed in patients who received all four recommended post-acute myocardial infarction (AMI) therapies. These include beta-blockers, antiplatelets, lipid-lowering drugs and renin-angiotensin-aldosterone system inhibitors. The results of the article appearing in theCanadian Journal of Cardiologypublished by Elsevier, may guide future clinical approaches to the management of AMI in nonagenarians and centenarians.

Life expectancy has steadily increased over time. In 2021, there were more than 861,000 Canadians who were 85 years old, an age group that is rapidly increasing in developed countries around the world. Because age is an independent risk factor for the development of cardiovascular disease, there is growing evidence for the treatment of this older population.

The lead investigator of the article "Guideline-directed medical therapy in non-agenarians and centenarians (≥ 90 years old) after first myocardial infarction-a national registration study" Ching-Hui Sia, MBBS, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and Department of Cardiology, Cardiology, Cardiology, Lays, Lays, Lays, Lays, Lays, Lays,,"As clinicians, we are often hesitant to prescribe GDMT for non-agenarians and centenarians with AMI. This reluctance is fostered by concerns about polypharmacy, a high comorbidity burden, frailty, and the risk of adversarial drug reactions such as postural hypotension, which may in fact be associated with worse survival outcomes."

Researchers conducted a retrospective cohort study using the National Myocardial Infarction Registry in Singapore, including 3,264 patients aged 90 years who had a non-impact myocardial infarction between 2007 and 2020. They compared survival between groups according to the number of GDMTs prescribed (0, 1-2, 3 or 4). The analysis showed that prescribing any number of GDMTs was associated with improved survival, with the greatest benefit seen in patients who received all four recommended therapies.

This is the largest study to date to evaluate post-myocardial infarction (MI) in patients aged 90 years and older using data from a national registry in a high-performing, well-structured healthcare system. The timely and important results provide real-world evidence that can help inform more confident prescribing practices for very elderly patients.

Coauthor of the accompanying editorial “Medical Management for Patients 90 Years Old and Up After Acute Coronary Syndrome—Never Too Old,” Karen B. Ho, MD, Division or Cardiology, Department of Medicine, Mazankowski Heart Institute, Edmonton, notes,"Despite the significant attention given to the adverse effects of polypharmacy, under-prescription in the elderly is an increasingly recognized and important problem. The appropriate management of acute coronary syndrome (ACS) in this age group is difficult due to a lack of evidence and concerns about the tolerability and safety of medications. The therapy, the better.

Editorial co-author Michelle M. Graham, MD, Division or Cardiology, Department of Medicine, Mazankowski Heart Institute, Edmonton, adds that"The center of the discussion is to consider what older adults value. In this study, the primary outcome was overall mortality. However, for patients of very advanced age, quality of life may be as important as their quality of life. Avoid repeat visits to the emergency room, and repeat hospitalization visits and rehospitalization and maintaining independence, the prerequisites of independence can be promised supplies in arousing grants. Older adults should consider the impact of medical therapy guidelines on patients-more important Highlight outcomes such as functional and cognitive capacity and days out of hospital.”

Dr. Sia concludes,"Our results suggest that physicians should carefully evaluate any decision to aggressively manage a patient with GDMT unless there is a justifiable reason. Advanced age alone does not appear to be a sufficient reason to limit the prescription of GDMTs. Of course, the benefits of GDMTs must always be balanced against the potential risks when presented to non-agenarians and centaurs who do not place them in the centenarians and to the centenarians to administer them properly result.

Sources: