The following is a summary of “Health Status and Clinical Outcomes in Older Adults With Chronic Coronary Disease: The ISCHEMIA Trial,” published in the May 2023 issue of Cardiology by Nguyen, et al.
The impact of age on health status and clinical outcomes in older vs. younger adults with chronic coronary disease and moderate or severe ischemia undergoing invasive or conservative management is poorly understood. For a study, researchers sought to examine the influence of age on health status and clinical outcomes in the ISCHEMIA trial, comparing invasive and conservative management strategies.
The study assessed one-year angina-specific health status using the Seattle Angina Questionnaire (SAQ) in 4,617 participants. The SAQ score ranges from 0 to 100, with higher scores indicating better health status. Cox proportional hazards models were used to estimate the treatment effect of invasive vs. conservative management, taking into account age, on the composite clinical outcome of cardiovascular death, myocardial infarction, or hospitalization for resuscitated cardiac arrest, unstable angina, or heart failure.
Among the participants, 2,239 (48.5%) were aged <65 years, 1,713 (37.1%) were aged 65 to 74 years, and 665 (14.4%) were aged ≥75 years. Baseline SAQ summary scores were lower in participants aged <65 years. After adjusting for various factors, the differences in 1-year SAQ summary scores (invasive minus conservative) were 4.90 (95% CI: 3.56-6.24) at age 55 years, 3.48 (95% CI: 2.40-4.57) at age 65 years, and 2.13 (95% CI: 0.75-3.51) at age 75 years (Pinteraction = 0.008). The improvement in SAQ Angina Frequency was less dependent on age (Pinteraction = 0.08). There were no significant age differences between invasive and conservative management regarding the composite clinical outcome (Pinteraction = 0.29).
Among patients with chronic coronary disease and moderate or severe ischemia, older individuals showed consistent improvement in angina frequency. Still, they had less improvement in angina-related health status than younger patients undergoing invasive management. Additionally, invasive management did not demonstrate improved clinical outcomes in older or younger patients. The findings suggested that the benefits of invasive management may vary based on age and highlight the importance of considering age-related factors in treatment decisions for chronic coronary disease patients.