Changing nature of cardiac interventions in older adults

Abstract

Older adults represent a rapidly growing segment of the population in developed countries. Advancing age is the most powerful risk factor for the development of cardiovascular disease (CVD), and CVD-related mortality increases markedly in older individuals. Procedures for patients with CVD, including percutaneous coronary intervention, aortic valve replacement and implantable cardioverter defibrillators were all initially validated in younger individuals but are increasingly being applied in older adults who for the most part have been significantly understudied in clinical trials. While advanced age alone is not a contraindication to these procedures, with the advent of less invasive methods to manage CVD including percutaneous techniques to treat both coronary artery disease and valvular heart disease, future research will need to weigh the potential harms of intervention in a population of older adults with multiple medical comorbidities and complex physiologic phenotypes against outcomes that include preventing functional decline and improving quality of life.

Figure 1. Inpatient procedures including percutaneous coronary intervention, coronary artery bypass grafting, implantable cardioverter defibrillators and pacemaker valves by age in the USA in 2006

Data taken from [3].

Figure 2. Trend in revascularization strategies for patients hospitalized with acute myocardial infarction in Canada from 1996 to 2006

Cath: Cardiac catheterization; PCI: Percutaneous coronary intervention. Data taken from [21].

Figure 3. Proportion of aortic valve recipients ≥80 years of age in the Society of Thoracic Surgeons Database in 1997 versus 2006

AVR: Aortic valve replacement. Data taken from [5].

Figure 4. Number of implantable cardioverter defibrillators placed in the USA from 1997 to 2006

ICD: Implantable cardioverter defibrillator. Data taken from [6,64].