Predicting Heart Events in the Elderly

ECG identifies seniors at added coronary heart disease risk

(RxWiki News) Doctors may have found another method for identifying seemingly healthy elderly patients with an increased risk of developing coronary heart disease or a subsequent heart attack.

Even minor electrocardiographic (ECG) abnormalities could predict heart disease in older adults beyond traditional cardiovascular risk factors.

"Ask a cardiologist about abnormalities found on ECGs."

Dr. Reto Auer, of the University of Lausanne, Switzerland, and University of California, San Francisco, noted in the study that older adults have a higher prevalence of both heart disease and ECG abnormalities, and that incorporating cardiovascular risk prediction could be useful among this group.

During the study researchers followed 2,192 Caucasian and African-American patients between the ages of 70 and 79 with no known cardiovascular disease. During the 8-year study, participants received three ECGs -- one at the beginning of the study followed by ECGs every four years, ending in 2007. ECG abnormalities were classified as either minor or major.

About 23 percent of participants experienced major ECG abnormalities, while 13 percent had minor abnormalities. After a median of 8.2 years of follow up 101 participants had suffered heart attacks, 154 patients were hospitalized for chest pain or coronary revascularization, and 602 patients had died. Of those deaths, 96 were attributed to coronary heart disease.

After adjusting for factors including blood pressure, cholesterol, gender and smoking, patients who had suffered a minor ECG abnormality were found to be at a 35 percent increased risk of a coronary heart disease event, while those with major abnormalities were at an added 51 percent risk.

With the inclusion of ECG abnormalities to traditional risk factors, researchers reclassified 176 intermediate risk patients, about 8 percent, as high risk. In addition, 136 participants, 6.2 percent, were reclassified as low risk.

Four years later, 416 patients had persistent abnormalities while 208 participants had developed new abnormalities. Both were associated with an increased risk of subsequent coronary heart disease events.

Dr. Auer noted that risk prediction using traditional risk factors is less accurate in older adults. He said that safe, low-cost ECGs could be useful in improving risk prediction among this category of patients.

In an accompanying editorial, Dr. Philip Greenland, of the Northwestern University Feinberg School of Medicine, questioned whether screening patients without symptoms would be beneficial.

"For the time being, in the absence of clear evidence of benefit and no clear implications for costs, the best advice is not to perform ECGs in asymptomatic patients, regardless of age. However, a careful and detailed cost-effectiveness analysis would be a useful next step in the translation of the cumulative risk information into an evidence-based practice recommendation," he wrote.

The study was recently published in the Journal of the American Medical Association.

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Review Date: 
April 9, 2012