{"id":6384,"date":"2025-02-15T13:53:33","date_gmt":"2025-02-15T13:53:33","guid":{"rendered":"https:\/\/site.itshrt.com\/worldnews\/new-insights-into-older-hearts-2\/"},"modified":"2025-02-15T13:53:33","modified_gmt":"2025-02-15T13:53:33","slug":"new-insights-into-older-hearts-2","status":"publish","type":"post","link":"https:\/\/site.itshrt.com\/worldnews\/new-insights-into-older-hearts-2\/","title":{"rendered":"New Insights Into Older Hearts"},"content":{"rendered":"<p> <script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-6606220950177433\"\r\n     crossorigin=\"anonymous\"><\/script>\r\n<!-- ItShrt World News -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-6606220950177433\"\r\n     data-ad-slot=\"1882483372\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\r\n<br \/>\n<\/p>\n<div data-testid=\"companionColumn-0\">\n<div class=\"css-53u6y8\">\n<p class=\"css-at9mc1 evys1bk0\">It turns out that the Isley Brothers, who sang that 1966 Motown hit \u201cThis Old Heart of Mine (Is Weak for You),\u201d were onto something when they linked age to an aching and flagging heart.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Heart disease, the nation\u2019s leading cause of death and disability, has been diagnosed in about 6 percent of Americans ages 45 to 64, but in more than 18 percent of those over 65, <a class=\"css-yywogo\" href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/71\/wr\/mm7123a4.htm\" title=\"\" rel=\"noopener noreferrer\" target=\"_blank\">according to the Centers for Disease Control and Prevention.<\/a><\/p>\n<p class=\"css-at9mc1 evys1bk0\">Old hearts are physiologically different. \u201cThe heart gets stiffer as we age,\u201d said Dr. John Dodson, director of the geriatric cardiology program at NYU Langone Health. \u201cIt doesn\u2019t fill with blood as easily. The muscles don\u2019t relax as well.\u201d<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Age also changes the blood vessels, which can grow rigid and cause hypertension, and the nerve fibers that send electrical impulses to the heart. It affects other organs and systems that play a role in cardiovascular health, too. \u201cAfter age 75 is when things accelerate,\u201d Dr. Dodson said.<\/p>\n<\/div>\n<aside class=\"css-ew4tgv\" aria-label=\"companion column\"\/><\/div>\n<div data-testid=\"companionColumn-1\">\n<div class=\"css-53u6y8\">\n<p class=\"css-at9mc1 evys1bk0\">But in recent years, dramatic improvements in treatments for many kinds of cardiovascular conditions have helped reduce both <a class=\"css-yywogo\" href=\"https:\/\/www.thelancet.com\/journals\/lanpub\/article\/PIIS2468-2667(22)00027-5\/fulltext\" title=\"\" rel=\"noopener noreferrer\" target=\"_blank\">heart attacks<\/a> and <a class=\"css-yywogo\" href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC5268076\/\" title=\"\" rel=\"noopener noreferrer\" target=\"_blank\">cardiac deaths<\/a>.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">\u201cCardiology has been blessed with a lot of progress and research and drug development,\u201d said Dr. Karen Alexander, who teaches geriatric cardiology at Duke University. \u201cThe medications are better than ever, and we know how to use them better.\u201d<\/p>\n<p class=\"css-at9mc1 evys1bk0\">That can complicate decision-making for heart patients in their 70s and beyond, however. Certain procedures or regimens may not markedly extend the lives of older patients or improve the quality of their remaining years, especially if they have already suffered heart attacks and are contending with other illnesses as well.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">\u201cWe don\u2019t need to open an artery just because there\u2019s an artery to be opened,\u201d said Dr. Alexander, referring to inserting a stent. \u201cWe need to think of the whole person.\u201d<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Recent research indicates that some frequently used medical approaches don\u2019t pay off for older patients, while too few of them take advantage of one intervention that does.<\/p>\n<\/div>\n<aside class=\"css-ew4tgv\" aria-label=\"companion column\"\/><\/div>\n<div data-testid=\"companionColumn-2\">\n<div class=\"css-53u6y8\">\n<p class=\"css-at9mc1 evys1bk0\">Here\u2019s some of what researchers are learning about old hearts:<\/p>\n<h3 class=\"css-15h6bi9 e1gnsphs0\" id=\"link-375adee\"><span><strong class=\"css-8qgvsz ebyp5n10\">A Shock to the Heart<\/strong><\/span><\/h3>\n<p class=\"css-at9mc1 evys1bk0\">An implantable cardioverter defibrillator, or I.C.D., is a small battery-powered device that is placed under the skin and delivers a shock in the case of sudden cardiac arrest. \u201cIt\u2019s easy to sell these things to patients,\u201d said Dr. Daniel Matlock, a geriatrician and researcher at the University of Colorado. \u201cYou say, \u2018This can prevent sudden cardiac death.\u2019 The patient says, \u2018That sounds great.\u2019\u201d<\/p>\n<p class=\"css-at9mc1 evys1bk0\">In 2005, an <a class=\"css-yywogo\" href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa043399\" title=\"\" rel=\"noopener noreferrer\" target=\"_blank\">influential study<\/a> persuaded Medicare to cover I.C.D.s in patients with heart failure, even those without high-risk arrhythmias, and \u201cit just took off,\u201d Dr. Matlock said.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">From 2015 through September 2024, surgeons implanted 585,000 such devices in patients\u2019 chests, according to the American College of Cardiology\u2019s registry. That\u2019s probably an undercount, as not all hospitals participate in the registry.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">But in 2017, among patients with nonischemic heart failure (meaning that the heart isn\u2019t pumping effectively but there is no blocked artery), <a class=\"css-yywogo\" href=\"https:\/\/www.ahajournals.org\/doi\/epub\/10.1161\/CIRCULATIONAHA.117.028829\" title=\"\" rel=\"noopener noreferrer\" target=\"_blank\">another influential study<\/a> showed that I.C.D.s did not reduce mortality for patients over 70. The device only prevented sudden cardiac deaths, the authors noted \u2014 and those occur more frequently in younger patients.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Moreover, \u201cat 85 or 90, sudden death is not necessarily the worst thing that can happen,\u201d Dr. Matlock said, compared to death from \u201cprogressive heart failure, which can go quickly or last for years; it\u2019s unpredictable.\u201d The wallop of an I.C.D. shock can also frighten and distress older patients, who often are unaware that the device can be deactivated with a computer.<\/p>\n<\/div>\n<aside class=\"css-ew4tgv\" aria-label=\"companion column\"\/><\/div>\n<div data-testid=\"companionColumn-3\">\n<div class=\"css-53u6y8\">\n<p class=\"css-at9mc1 evys1bk0\">Cardiologists and researchers still <a class=\"css-yywogo\" href=\"https:\/\/www.ahajournals.org\/doi\/epub\/10.1161\/CIRCULATIONAHA.117.030935\" title=\"\" rel=\"noopener noreferrer\" target=\"_blank\">debate how much I.C.D.s benefit older patients<\/a>. But because cardiac drugs have grown so much more potent since 2005, a <a class=\"css-yywogo\" href=\"https:\/\/www.pcori.org\/research-results\/2024\/comparative-effectiveness-icd-versus-non-icd-therapy-contemporary-heart-failure-patients-low-risk-arrhythmic-death-contemp-icd\" title=\"\" rel=\"noopener noreferrer\" target=\"_blank\">major multisite study is underway<\/a> to determine, among patients at lower risk of sudden death, whether medications alone might now be more effective.<\/p>\n<h3 class=\"css-15h6bi9 e1gnsphs0\" id=\"link-5b30c11e\"><span>Invasive procedures<\/span><\/h3>\n<p class=\"css-at9mc1 evys1bk0\">Medications alone already appear to be at least as effective in treating older people who have suffered the kind of heart attacks not caused by a suddenly and completely blocked artery. (Technically these are referred to as NSTEMI, for non-ST-segment elevation myocardial infarction.)<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Half of these occur in people over 70, said Dr. Vijay Kunadian, a professor of interventional cardiology at Newcastle University in England and the lead author of a recent study in The New England Journal of Medicine.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">\u201cOlder people often are underrepresented in research,\u201d Dr. Kunadian said. \u201cThere are a lot of preconceived biases.\u201d So her team recruited an older-than-typical sample (average age 82) in which to compare the benefits of conservative and invasive treatment.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Half of the 1,500 patients <a class=\"css-yywogo\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/39225274\/\" title=\"\" rel=\"noopener noreferrer\" target=\"_blank\">in the study<\/a> began a regimen of cardiac medications that included blood thinners, statins, beta blockers and ACE inhibitors. The other half had more invasive treatment, starting with an angiogram (an X-ray of the blood vessels). Then, roughly half of that group received a stent or, in much smaller numbers, underwent bypass surgery. These patients were also prescribed the same kinds of medications as the patients who were treated with drugs alone.<\/p>\n<\/div>\n<aside class=\"css-ew4tgv\" aria-label=\"companion column\"\/><\/div>\n<div data-testid=\"companionColumn-4\">\n<div class=\"css-53u6y8\">\n<p class=\"css-at9mc1 evys1bk0\">Over four years, the team found no difference in the patients\u2019 risk of cardiovascular death or a nonfatal heart attack. Although surgical risks generally rise with age, complications were low in both groups.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Facing such situations, older patients and their families need to ask important questions, Dr. Alexander said: \u201cHow is this going to help me, and what are the other options, especially if it\u2019s invasive? Is it necessary? What if I don\u2019t do this?\u201d<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Dr. Kunadian agreed. \u201cOne size does not fit all in this group,\u201d she said. Invasive treatment did not benefit patients, but it didn\u2019t harm them, either.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">Still, Dr. Kunadian said, \u201cif they\u2019re very frail, living in a nursing home with dementia, with a number of other conditions, it\u2019s reasonable to say it\u2019s in their best interest to use medical therapy alone.\u201d<\/p>\n<h3 class=\"css-15h6bi9 e1gnsphs0\" id=\"link-4f5d0489\"><span><strong class=\"css-8qgvsz ebyp5n10\">Cardiac Rehabilitation<\/strong><\/span><\/h3>\n<p class=\"css-at9mc1 evys1bk0\">One intervention known to benefit patients with heart disease is cardiac rehabilitation: a program of regular, supervised exercise that significantly <a class=\"css-yywogo\" href=\"https:\/\/www.cochrane.org\/CD001800\/VASC_exercise-based-rehabilitation-coronary-heart-disease\" title=\"\" rel=\"noopener noreferrer\" target=\"_blank\">reduces heart attacks, hospitalization and cardiovascular deaths<\/a>.<\/p>\n<\/div>\n<aside class=\"css-ew4tgv\" aria-label=\"companion column\"\/><\/div>\n<div data-testid=\"companionColumn-5\">\n<div class=\"css-53u6y8\">\n<p class=\"css-at9mc1 evys1bk0\">But cardiac rehab remains perennially underused. Only about one-quarter of eligible patients participate, Dr. Dodson said, and among older adults, who could benefit even more, the proportion is lower still.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">\u201cThere are <a class=\"css-yywogo\" href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC2928243\/\" title=\"\" rel=\"noopener noreferrer\" target=\"_blank\">barriers for people<\/a> in the 70s and 80s,\u201d he said. They have to show up at a facility to exercise, so sometimes \u201ctransportation is a problem.\u201d<\/p>\n<p class=\"css-at9mc1 evys1bk0\">And, he added, \u201cpeople can get deconditioned or afraid of activity. They may worry about falling.\u201d<\/p>\n<p class=\"css-at9mc1 evys1bk0\">The in-person NYU Langone program involves three exercise sessions a week for three months, with nutritional and psychological counseling. Since enrollment among seniors had been disappointing, researchers tried replicating it with <a class=\"css-yywogo\" href=\"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2828802\" title=\"\" rel=\"noopener noreferrer\" target=\"_blank\">a remote program<\/a>.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">They offered it to patients (average age 71) with ischemic heart disease (caused by narrowed arteries, which impede blood and oxygen flow to the heart) who had suffered a heart attack or undergone a stent procedure. Each received a tablet computer and broadband access so that they could undertake a rehab program at home. An exercise therapist checked in by phone weekly.<\/p>\n<p class=\"css-at9mc1 evys1bk0\">At-home participation fell off over time, however. After three months, those assigned to remote rehab showed no greater functional capacity \u2014 measured by how far they could walk in six minutes \u2014 than a similar group who followed the usual care.<\/p>\n<\/div>\n<aside class=\"css-ew4tgv\" aria-label=\"companion column\"\/><\/div>\n<div data-testid=\"companionColumn-6\">\n<div class=\"css-53u6y8\">\n<p class=\"css-at9mc1 evys1bk0\">Was that because seniors struggled with the technology? Or feared exercising with heart problems? Would working out in person, alongside others on treadmills and elliptical trainers, inspire more engagement?<\/p>\n<p class=\"css-at9mc1 evys1bk0\">\u201cWe need to figure out the delivery system that\u2019s most effective,\u201d Dr. Dodson said. \u201cWhat\u2019s most motivating for older patients?\u201d He\u2019ll be trying again.<\/p>\n<\/div>\n<aside class=\"css-ew4tgv\" aria-label=\"companion column\"\/><\/div>\n<p><script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-6606220950177433\"\r\n     crossorigin=\"anonymous\"><\/script>\r\n<!-- ItShrt World News -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-6606220950177433\"\r\n     data-ad-slot=\"1882483372\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\r\n<br \/>\n<br \/><a href=\"https:\/\/www.nytimes.com\/2025\/02\/15\/health\/heart-disease-aging.html\">Source link <\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>It turns out that the Isley Brothers, who sang that 1966 Motown hit \u201cThis Old Heart of Mine (Is Weak<\/p>\n","protected":false},"author":1,"featured_media":6385,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[38],"tags":[2504,2505,2508,139,1412,2506,2163,2503,2509,2507,1621,636,188],"class_list":["post-6384","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-science","tag-age","tag-chronological","tag-defibrillators","tag-drugs-pharmaceuticals","tag-elderly","tag-exercise","tag-heart","tag-medical-devices","tag-new-york-university-langone-health","tag-stents-medical-devices","tag-therapy-and-rehabilitation","tag-your-feed-health","tag-your-feed-science"],"yoast_head":"<!-- This site is optimized with the Yoast 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