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Drug therapy may be comparable to invasive cardiac procedures for elderly patients with heart attack

al treatment, regardless of age, clinical indication, or risk profile. The absolute unadjusted difference in 7-year survival between regions providing the highest rates of both invasive and medical management strategies and those providing the lowest rates of both was 6.2 percent."

"Our study confirmed that clinicians were more likely to provide invasive treatments to lower-risk than higher-risk patients in this population, despite evidence demonstrating that these treatments are associated with greater absolute improvements in older, higher-risk patients," the authors write. "Second, a more intensive medical management style was associated with improved survival regardless of the level of invasive management in the region; however, in regions with high medical management intensity, there appeared to be little or no marginal improvement associated with additional invasive treatment."

In conclusion the authors write: "Debate continues regarding the value of routine use of high technology treatment for cardiac patients. While AMI survival has improved compared with 30 years ago, invasive treatment and medical management are not optimal as practiced in the United States. We recommend first, that a comprehensive, systems-minded approach to delivering evidence-based medical management to AMI patients be a national priority."


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Contact: Julie Argles
416-480-4780
JAMA and Archives Journals
15-Mar-2005


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