Medications may prolong frail seniors’ lives after heart attacks but affect function

A new study has shown that frail elderly may live longer after suffering a heart attack by taking several prescribed medications to prevent any future heart problems, however such intake may also lead to increased frailty. Statistically, seniors living in nursing homes who took three or more medications within 90 days of an attack were less likely to die than those who took just one; in some cases though, functional decline was more common with more medications.

Andrew Zullo, from the Brown University School of Public Health in Rhode Island, and his team analyzed data between 2007-2010 from more than 4,700 nursing home residents over the age of 65. The medications that the residents took after heart attacks included blood thinners, anticholesterol drugs, blood pressure drugs, renin-angiotensin-aldosterone system inhibitor drugs.

Study results

The team compared people who were taking one, two, or three or more drugs to see their conditions (death, rehospitalization, functional decline) 90 days after a heart attack. Overall there were more than 500 deaths, 1,200 rehospitalizations and 800 instances of functional decline. Zullo and colleagues also found that patients who took multiple medications were 26% less likely to die during the given timeline than those who took only one.

However they also found that using more secondary prevention medications was associated with a 30% increase in functional decline, “This disagreement means that the functional outcome results must be interpreted with extra caution,” Zullo said. Though such medications are recommended for all adults, even for the frail elderly, Zullo added that little data is available about their effectiveness and safety for the extremely frail and elderly – particularly with regard to physical functioning.

As the average of suffering a first heart attack occurs in late years – 65 for men, 72 for women -, seniors make up a large portion of patients who need prevention medications. “Many frail older adults value maintaining independence and quality of life more than simply living longer,” said Zullo, “We should ensure that treatment helps older adults to achieve their care goals.”

Further finding and research

The team noted that their findings have some limitations, examples being patients who suffer multiple severe heart attacks receive more medication, or patients who were extremely frail received less medication. No information on medication dosages were included.

Zullo said that future studies should look into the effects of certain medication combinations, dosages, over-the-counter medicines; he also recommended researchers follow-up with patients after a year to understand long-term outcomes.

Susan Bowles from Dalhousie University and the Nova Scotia Health Authority in Canada wrote a commentary accompanying the study noting that “older frail adults are at greater risk of experiencing medication-related harms.” She also comments that medication intake-related decisions require consideration of potential benefits and risks for patients.

“Clinicians and patients are then presented with the quandary of what is the actual benefit of these treatments and if the potential for benefit exceeds the potential risk of harm,” said Bowles, “A better understanding of this would assist clinicians and patients in decision making.”

Story by Reuters

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