Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, March 21, 1995 TAG: 9503210156
SECTION: NATIONAL/INTERNATIONAL PAGE: A-3 EDITION: METRO
SOURCE: Associated Press
DATELINE: NEW ORLEANS LENGTH: Medium
With little fanfare, the artery-clearing procedure has rapidly evolved from a technique reserved for the relatively young and fit to one increasingly being done on people in their 80s and 90s, according to a study released Monday.
The change is attributed in part to better instruments that give doctors the confidence to try this approach on riskier patients. But it also raises questions about whether such costly and invasive techniques make sense, either for the elderly patients or as a way to use health care dollars.
Angioplasty involves temporarily inflating tiny balloons in the heart arteries to open blockages.
Dr. James G. Jollis and colleagues from Duke University analyzed Medicare records from 1987 to 1992 and found the use of angioplasty in men and women over age 80 nearly quadrupled. These elderly patients are three times more likely than people in their late 60s to die in the hospital from the procedure.
In all, about 5 percent of the 420,000 angioplasties performed annually are done on people in their 80s and beyond. During the years studied, eight angioplasty patients were 98 or older.
``It's a huge change,'' Jollis said. Until recent years, ``it was rarely done on somebody in their 80s.''
About 20 percent of people over 80 have coronary artery disease. The disorder can cause chest pain called angina. Doctors routinely try to control the pain with medicine, but this can be especially difficult in old people, who are more likely to experience dizziness and other drug side effects.
When drugs fail, doctors may offer angioplasty or coronary bypass surgery. Bypass, which often has longer-lasting results than angioplasty, involves using pieces of blood vessel to detour blood around the blockages.
Earlier work by the Duke team showed that bypass surgery, too, has grown dramatically among the elderly. Among their findings:
In 1987, U.S. doctors performed 3,050 angioplasties and 4,534 bypasses on people over 80. By 1992, this had grown to 11,490 angioplasties and 9,979 bypasses.
Seven percent of elderly angioplasty patients died in the hospital, compared with 2 percent of patients ages 65 to 69. Death rates after bypass were 11 percent for the elderly and 4 percent in the younger patients.
One year after angioplasty, 16 percent of the elderly patients had died, compared with 5 percent of those who got the procedure in their late 60s. By comparison, 18 percent of elderly bypass patients had died, as had 8 percent of younger ones.
Routine angioplasty typically costs $15,000 to $20,000.
by CNB