American Heart Association Updates Recommendations for Age-appropriate Heart Disease Care

As bodies age, heart muscles and arteries can change in ways that increase the risk for heart disease. According to the American Heart Association (AHA), age should be considered in the diagnosis and treatment of heart disease. To that end, the AHA  published a scientific statement in Circulation updating its age-appropriate heart disease care recommendations.

Acute coronary syndrome (ACS) is a group of conditions in which blood flow to the heart is reduced, including angina and heart attacks, or myocardial infarctions.  According to the AHA,  “ACS is more likely to occur without chest pain in older adults, presenting with symptoms such as shortness of breath, fainting or sudden confusion.”

“Management of Acute Coronary Syndrome (ACS) in the Older Adult Population,” highlights normal aging and age-related changes in the heart and blood vessels, and acknowledges that older adults often have multiple medical conditions and medications complicating diagnosis and treatment.  

For example, large arteries and the heart muscle become stiffer with age, and the heart may work harder but pump blood less efficiently. Many normal changes increase the risk of blood clots.

“Age-related changes in metabolism, weight and muscle mass may necessitate different choices in anti-clotting medications to lower bleeding risk,” according to a press release. Kidney function also declines with age. 

One of the issues the authors highlight is that clinical practice guidelines are based on clinical trial research, but older adults are often not included in trials because their health care needs are more complex when compared to younger patients. 

According to said Abdulla A. Damluji, chair of the scientific statement writing committee and an associate professor of medicine at Johns Hopkins School of Medicine in Baltimore, “[o]lder patients have more pronounced anatomical changes and more severe functional impairment, and they are more likely to have additional health conditions not related to heart disease." “These include frailty, other chronic disorders (treated with multiple medications), physical dysfunction, cognitive decline and/or urinary incontinence – and these are not regularly studied in the context of ACS.” 

The authors emphasize the need to look beyond the clinical outcomes for older adults, like bleeding, stroke, and heart attack, and to also focus on quality of life and the ability to live independently and/or return to their previous lifestyle or living environment. 

England's NHS Saves Lives with World Leading "Dead" Heart Transplants

More than 3,000 heart transplants were performed in the United States last year, according to the federal Organ Procurement Transportation Network (OPTN). These 3,000-plus patients were given the gift of life through the selfless act of organ donation by individuals and families who were faced with the opportunity to make a positive impact in the wake of tragedy. 

This number is truly amazing; the first successful heart transplant was performed  a little more than 50 years ago. Since then, heart transplantation has become more routine,  almost considered as routine as a bypass surgery. With advances in transplant technology, more people are seeking heart transplantation.  Tragically, there simply are not enough donor hearts to go around.  

There are currently nearly 4,000 people across the U.S. awaiting donor hearts, according to OPTN data. Unfortunately, a significant number of patients die before suitable donor hearts become available for transplantation. To meet this ever-growing need, the medical community seeks new and advanced procedures and treatments for heart failure while educating healthy community members how truly life-changing the gift of organ donation is for recipients, donors, and their families.

Finding a healthy living heart suitable and available for donation is difficult.  What if, however, hearts that had stopped could be used in donation.  What was once though impossible or unlikely may someday be routine, thanks to the doctors in England's National Health Service (NHS).

Anna Hadley, a 16-year-old from Worcester, waited for nearly two years for a new heart. Now, almost two years later, Anna is healthy and playing hockey again. Anna has British surgeons to thank, as they "carried out the world's first transplants in children using dead hearts that were brought back to life." 

The surgeons used a pioneering machine to reanimate hearts from donors whose hearts stopped. So far, use of the machine has saved the lives of six British children ranging in age form 12 to 16. Each of the transplants occurred during the pandemic. 

Anna was the first to have her life saved by the pioneering machine. She received the call at 2:30am after she had waited almost two years after being diagnosed with restrictive cardiomyopathy. 

Within 24 hours of the operation, Anna was sitting up in bed. Within weeks, Anna was playing hockey again. Anna said, "I just feel normal again. There's nothing I cannot do now."

Source: Andrew Gregory, NHS saves children’s lives with world-first ‘dead’ heart transplants, The Sunday Times (U.K.), February 20, 2021.