Researchers at the University of Edinburgh are part of a clinical trial supported by the British Heart Foundation (BHF), which will investigate if current UK practices are in line with the needs of our ageing population. The study aims to find the most suitable way to treat patients aged 75 and over who have had a heart attack.
The Edinburgh team, led by BHF Professor of Cardiology David Newby, are part of a UK-wide clinical trial, led by researchers at the Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University who have been awarded £1.7million from the BHF.
Coronary heart disease (CHD) is Scotland’s single biggest killer and the leading cause of death worldwide. CHD is responsible for the deaths of nearly 7,000 Scots each year and most of these are caused by a heart attack.
Although there have been advances in how CHD is treated, little research has been carried out to look at how best to treat older patients despite the fact that 50% of heart attacks happen in patients aged 72 and over.
The UK-wide trial, known as SENIOR-RITA, hopes to find 2,300 patients across 40 different hospitals across the UK over a two-year period to take part in the trial. In Scotland, the trial is headed up by Professor David Newby.
He explained: “There is much debate and conflicting views amongst doctors about how to treat patients over 75 years old who present with a heart attack. This is because of the lack of evidence in older patients who may have both benefits and harms from treatments. As people are now living longer, it’s really important we carry out this research to identify how best to manage our patients to ensure they receive the best care available and enhance their chances of recovery.
Currently 86% of older patients (85 and over) who have a heart attack are given medication to treat their condition rather than combined treatment involving medication and a procedure known as a coronary angioplasty, which clears blockages in the heart arteries using a balloon and a metal scaffold, known as a stent. This is compared to 17% of patients aged 18 to 65 years old, demonstrating huge disparity in treatments based on age.
Many clinicians believe older patients are frail, have a lower chance of survival and are more likely to have complications after heart procedures. However, this is based on perception rather than evidence-based research.
The clinical trial will look to determine whether patients over the age of 75 will benefit from a coronary angiography and angioplasty after having a minor heart attack. Patients on the trial will be randomised to have either the procedure alongside medication or receive medication in keeping with the current practice.
Brian Thompson, who is 83, had a stent fitted as part of the first phase of the trial in Newcastle in the summer.
He said: “I had my heart attack in June of this year and I’m very lucky that I’ve been able to carry on with my life with my wife. It made sense for me to take part in the trial as it will help doctors make better decisions for patients like me. It has been a good experience dealing with the doctors and research nurses at the Freeman Hospital. I’ve also had the opportunity to see my own scans and talk to them about my heart and what we will be doing going forward. It feels good to know that I’m part of something that will help not just people in my generation, but for those in the future as well.”
Professor Jeremy Pearson, Associate Medical Director at the BHF, said: “This trial marks a landmark study in improving the care of older heart attack patients. Co-ordinating patients, research staff and clinicians across 40 sites is no mean feat and it will help answer important questions that doctors have when deciding whether to treat older, frailer patients with stents or bypasses.
“Treatments can often carry a risk and there is much more to be done to make sure treatments are suitable for every kind of patient. A heart attack still has the power to devastate a person and their family and we need to keep funding research to find the breakthroughs that will make a difference.”
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