Geriatric Cardiac Surgery: Reducing the Risk
MADISON - More than 80 percent of deaths from cardiovascular disease in the United States occur in people aged 65 and older. With continued increases in life expectancy comes greater need for safe, effective cardiac procedures in older patients.
"While cardiac surgery involves risk, no matter the age, geriatric cardiac surgery has become a viable and often successful option that can improve the quality of life for older patients," says Niloo Edwards, MD, a UW Health cardiothoracic surgeon and co-author of Aging, Heart Disease and its Management: Facts and Controversies.
UW Health's numbers bear out the national trends - in 2007, more than half of CABG patients at UW Hospital were 65 or older. The average age of a CABG (on pump) patient was 67 years old, and the average age of CABG (off pump) patients was 70.5 years old. These numbers fly in the face of the common misperception that older patients are precluded from more aggressive cardiac therapies solely on the basis of their age.
A Specialized Approach to Geriatric Cardiac Care
Success rates, according to Dr. Edwards, rely on taking a more specialized approach to geriatric cardiac care. This includes a more intense evaluation process - identifying and diagnosing any co-morbidities and reviewing the risks and benefits with the patient and their family. Evaluation also includes an assessment of the patient's social situation.
A thorough, personalized plan of rehabilitation is in place before surgery to help the patient heal. Extraordinary changes to the clinical pathways are rarely needed - minor modifications to rehabilitation and recovery times lead to results similar to those of younger patients.
"The other concern with older patients is post-operative complications, stroke in particular," Dr. Edwards says. "Increased age can lead to a greater risk for postoperative bleeding or wound infections as well. Being aware of these risks and planning in advance for them is a critical part of geriatric cardiac surgery."
Stroke is a leading cause of serious, long-term disability for older Americans - about 88 percent of stroke deaths occur in people aged 65 and older. However, for half of all geriatric heart patients the risk of a stroke significantly decreases in the months following surgery. Other independent studies suggest that the risks of a stroke following cardiac surgery are due to many independent factors, not necessarily age alone.
As with most medical conditions, early detection and evaluation is key, regardless of age.
"Diagnosing heart problems before the onset of heart failure or chronic heart disease is one of the most significant things we can do to improve survival rates," Dr. Edwards says. "Emergency heart procedures are two to 10 times more risky than planned procedures. If we can head something off before it becomes critical, we can greatly improve quality of life."
Date published: 4/28/2008