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Heart surgery aids elderly with diabetes, angina

August 1, 2005

By David Douglas

NEW YORK (Reuters Health) – Elderly diabetic patients with
chronic heart-related chest pain — angina — benefit from
surgery to open blocked coronary arteries to the same degree as
similar heart patients without diabetes, according to Swiss
researchers.

As senior investigator Dr. Mathias E. Pfisterer told
Reuters Health, “elderly patients and their physicians may
choose either an invasive strategy … or a medical strategy
with a similar long-term outcome.”

Each choice has it pros and cons, he pointed out. Heart
surgery provides “early symptom relief and improvement in
well-being,” but involves considerable cost; on the other hand,
medical management entails “more drugs and a greater than 50
percent chance of the need for late revascularization” — ie,
surgery or angioplasty to restore bloodflow to the heart
muscle.

Pfisterer of University Hospital Basel and colleagues
evaluated 301 patients 75 years of age or older with
symptomatic coronary artery disease. Sixty-nine subjects also
had diabetes.

The team examined the difference in outcome over 4 years
between the diabetic and nondiabetic patients, and reported the
findings in the American Journal of Cardiology.

Compared with non-diabetics, people with diabetes had more
hypertension, risk factors, previous heart failure and heart
attacks. However, in both groups, the overall survival was 61
percent without revascularization, compared to 79 percent with
revascularization.

Pfisterer also noted that cost analysis showed that the
early increased costs of heart surgery are balanced by
increased doctor’s fees and late surgery costs in
medical-strategy patients.

“Increased intervention costs should not be an argument to
withhold the invasive strategy from elderly patients with
symptomatic chronic coronary artery disease,” he concluded,
whether or not they have diabetes.

SOURCE: American Journal of Cardiology, July 2005.




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