A recent study of survival rates for adults with heart failure was a wake up call for doctors dealing with elderly patients. The results were much worse than indicated by previous trials and the news is particularly bad for older adults.
The study, headed by Dr. Philip Jong of the Toronto-based Institute for Clinical Evaluative Sciences, tracked the mortality rates of more than 38,000 Ontario patients, hospitalized for heart failure between 1994 and 1997. It found that 33 per cent of patients died within a year of hospitalization and that figure rose to 40 per cent for the 75-plus population, compared with only 14 per cent for those under 50. Previous clinical studies put the overall one-year mortality rate at eight to 13 per cent.
"This is a wake up call that we need to treat elderly patients with heart disease as effectively as we do younger patients," says Dr. Peter Liu, co-author of the study and a cardiologist at Toronto General Hospital. He adds that clinical trials generally look at younger patients since they are the ones who tend to volunteer.
Studies in the United States and Europe have found a large discrepancy between survival rates of heart failure patients in the general population and those in clinical trials. "We are the first and largest study to show that this discrepancy also exists in the Canadian population," says Jong.
Liu speculates that the over-75 group may have a high mortality rate because the nature of the disease makes it easy to overlook. "The symptoms of heart failure – feeling tired, swelling ankles, and shortness of breath – are not dramatic. A lot of people think ‘hey I’m just getting old’ so patients don’t pay much attention to it and physicians can miss it because people come in tired all the time."
Dr. Lyall Higginson, chief of cardiology at the Ottawa Heart Institute, agrees that doctors may not treat elderly patients the same as younger ones but suggests other reasons for the results.
Older patients often have other diseases going on which makes the heart failure more difficult to treat. "Often we don’t treat them as aggressively as we should – and for good reason. But there are times when we need to be more aggressive with the investigation, the management and the therapy," he says.