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    Study: Doctors Assess Health Risk in Elderly Survivors of Heart Attacks

    Physicians can use a few key indicators to predict which elderly survivors of heart attacks need the most attention, according to a new study published in the August 1st issue of the Journal of the American College of Cardiology. The study analyzed a population of more than 103,000 patients who survived first heart attacks at age 65 or older. It examined more than 80 possible risk factors and identified eight that are significantly useful in predicting the likelihood that such patients will survive the first year after a heart attack.

    The study pointed to older age, urinary incontinence, the need for assistance with mobility, heart failure, peripheral vascular disease, low body mass index, kidney dysfunction, and left ventricular dysfunction (impaired heart function) as key predictive factors physicians can use to focus their attention on the highest-risk patients.

    The study' s investigators used these factors to divide the population they studied into three groups: low risk, medium risk, and high risk. "About 40% of the cohort [patients in the study] was assigned to the low-risk group and 18% to the high-risk group. As expected, there was a strong correlation between a higher risk score and a greater risk of mortality."

    The study was conducted by researchers from the Yale University School of Medicine led by Harlan M. Krumholz, MD. "The challenge for the physician discharging a patient after an AMI [an acute myocardial infarction, a technical term for a heart attack] is to distinguish the patients who remain at a higher risk from the many relatively low risk patients," the authors commented.

    The study also confirms some intuitive notions about cardiac health risks and elderly people. "Frailty, as indicated by decreased functional status (urinary incontinence, inability to walk) and low body mass index [being underweight]& may indicate the absence of functional reserve and a susceptibility to a large number of mortality risks," according to Dr. Krumholz and colleagues.

    "We demonstrate that before employing either of the two major testing strategies (noninvasive stress testing and cardiac catheterization), physicians can estimate the risk of dying within one year after discharge with reasonable accuracy," they conclude.

    In a related editorial, Koon K. Teo, MB, PhD, of McMaster University in Hamilton, Ontario and Diane J. Catellier, DrPH, of the University of North Carolina at Chapel Hill note that "this is a model that clinicians would be able to apply to their patients without having to resort to sophisticated equipment and tests for risk stratification."

    The reviewers expressed concern, however, over the fact that the investigators did not include conventional predictors of risk such as the characteristics of each patient' s heart attack and the extent of each patient' s coronary disease among the factors they evaluated. They emphasize that physicians should not disregard these important factors in making their decisions. Instead, the non-cardiac risk factors discussed in the study "should be included in the decision-making process" along with more conventional factors when making treatment decisions for elderly patients.



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