It turns out that the Isley Brothers, who sang the 1966 Motown hit “This Old Heart of Mine (Is Weak for You),” were onto something. Their song intuited the connection between age and a faltering heart.
Heart disease remains the nation’s leading cause of death and disability. Approximately 6 percent of Americans aged 45 to 64 are diagnosed with heart disease, but this figure jumps to more than 18 percent for those over 65, according to the Centers for Disease Control and Prevention.
Old hearts undergo significant physiological changes. “The heart becomes stiffer with age,” explained Dr. John Dodson, director of the geriatric cardiology program at NYU Langone Health. “It fills with blood less efficiently, and cardiac muscle relaxation is impaired.”
Changes also occur in blood vessels, leading to increased rigidity and hypertension, and in nerve fibers that regulate heart function. These modifications extend to other systems crucial for cardiovascular health. “After age 75, changes accelerate,” Dr. Dodson noted.
Despite these challenges, significant advancements in cardiovascular treatments have drastically reduced heart attack rates and mortality, according to studies.
“Cardiology has seen substantial progress and improved drug development,” Dr. Karen Alexander, a geriatric cardiologist at Duke University, pointed out. “Medications are more effective, and we’ve refined their use.”
However, the aging population presents unique challenges in treatment decision-making. For seniors, certain interventions may not extend life expectancy or enhance quality of life if they have pre-existing conditions. “We focus on the whole person, not just one organ,” Dr. Alexander emphasized.
Research indicates that common medical approaches are often ineffective for older patients, while remote cardiac rehabilitation remains underutilized.
Recent studies provide insights into cardiovascular care for the elderly:
Implantable Cardioverter Defibrillators (ICDs)
ICDs are small devices that deliver shocks to prevent sudden cardiac death. “It’s easy to sell these to patients,” Dr. Daniel Matlock of the University of Colorado noted. “The promise of preventing sudden death is compelling.”
Yet, Medicare expanded their coverage in 2003, leading to a surge in implants. From 2015 to September 2024, 585,000 ICDs were implanted, possibly underreported as not all hospitals participate in the American College of Cardiology’s registry.
In 2017, a study on nonischemic heart failure patients over 70 revealed that ICDs do not reduce overall mortality. They only prevent sudden cardiac deaths, which are less common in older individuals. “Sudden death might not be the worst outcome at 85 or 90,” Dr. Matlock argued, adding that progressive heart failure can be equally or more distressing.
Furthermore, ICD shocks can be frightening for older patients. These devices can also be deactivated using a computer if necessary.
Ongoing debates surround the benefits of ICDs for seniors. However, a major study funded by the Patient-Centered Outcomes Research Institute aims to determine if medications alone might be more effective for those at lower risk of sudden death.
For older people who have experienced NSTEMIs (non-ST-segment elevation myocardial infarctions), medication seems as effective as invasive procedures. Dr. Vijay Kunadian, a professor of interventional cardiology, led a study published in The New England Journal of Medicine, which included 1,500 patients with an average age of 82.
Half of the participants received medical therapy alone, including blood thinners, statins, beta blockers, and ACE inhibitors. The other half underwent invasive treatments like angiograms or stents, followed by similar medications. Over four years, the risk of cardiovascular death or nonfatal heart attacks was no different between the two groups.
Dr. Alexander advised patients to ask about the necessity of procedures: “How will this benefit me? Are there alternatives? Is it necessary? What if I choose not to do this?” Dr. Kunadian echoed these sentiments: “One size doesn’t fit all, and invasive treatments may not be crucial for everyone.”
Cardiac Rehabilitation
A known intervention for heart disease is cardiac rehabilitation, which significantly reduces heart attacks, hospitalizations, and cardiovascular deaths, research shows.
However, cardiac rehab is underutilized. Only about one-quarter of eligible patients enroll, with older adults facing even lower participation rates. Dr. Dodson identified transportation issues as a barrier. “Seniors might find it hard to make it to facilities due to mobility or scheduling issues,” he stated.
Exercising and physical activity can also deter older patients, who fear falling or deconditioning. In-person NYU Langone programs involve weekly sessions, plus nutritional and psychological support. To address engagement issues, researchers tested a remote program with home exercise via tablet computers.
Unfortunately, remote participation waned over time, with no significant improvement in functional capacity compared to traditional care. “We need to determine the best delivery system and motivations for older patients,” Dr. Dodson concluded.
Understanding the unique needs and challenges of aging hearts is crucial for effective cardiovascular care. While progress in treatment has transformed heart health outcomes, aging introduces complexities that require tailored approaches.
The overreliance on certain medical devices and underutilization of rehabilitation highlight the need for a comprehensive and patient-centered strategy in senior care. As researchers continue to explore optimal treatments, proactive engagement and education for both patients and caregivers are imperative.
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