What is Better for my Elderly Cardiovascular Patient, Surgery or Pharmaceutical Intervention

Kimby N. Barton, MSc
Assistant Editor,
Geriatrics & Aging

With recent advances in medical interventions for the treatment of cardiovascular diseases, including the introduction of ACE inhibitors and the use of b-blockers for left ventricular dysfunction, the role of coronary revascularization in managing elderly cardiovascular patients has become more difficult to define. Unfortunately, the bulk of research in this area has either failed to compare treatments directly, or has excluded patients who are 65 years or older. Research in this field has also focussed on long-term benefits of surgery over medical treatment, which may not be as germane to an elderly patient as symptomatic improvements, given that this patient's life expectancy may be considerably shorter than that of someone younger. In addition, with the increased frailty that accompanies old age, perioperative mortality and postoperative complications are a much greater concern for elderly patients. They are at an increased risk for stroke, acute renal failure, and other major complications. All of these factors suggest that caution should be exercised when extrapolating data from younger patients and applying it to older ones.