Each year, more than a million Americans visit hospitals with severe symptoms of heart disease: chest pains, dizziness, not enough blood flow to the heart, and even heart attacks. Many of these heart attacks do not result in cardiac arrest (when the heart stops beating), and, more often than not, the heart attacks are not as severe as the classically defined heart attacks that require being rushed into treatment. The management of these less severe heart attacks has been a "raging debate" among physicians, according to Richard Bach, a cardiologist at Washington University Medical School in St. Louis. He and others attempted to sort out the best way to take care of elderly patients with these symptoms.

What the researchers wanted to know: What is the best way to treat patients older than 65 who have severe heart disease or milder heart attacks?

What they did: Bach and his colleagues used data from 2,220 patients in nine different countries who had severe heart disease and symptoms of a heart attack. Of those, 962 were older than 65, the main group studied (though data from all were used for comparison). After being stabilized and put on heart medications, the patients were treated either conservatively, using a treadmill cardiovascular "stress test" to determine the need for additional treatment, or invasively with an immediate angiography (an X-ray scan of blood vessels) and vascular treatment if warranted. The researchers followed up 30 days after the patient was discharged from the hospital and again after six months. They measured how many of the patients had another heart attack or died of coronary causes.

What they found: After six months, patients treated more invasively were 39 percent less likely to have another heart attack or die than patients treated with a more conservative, observational approach. The treatment method did not differ significantly in the outcomes of younger patients. In patients older than 75, the effect of invasive treatment was even more pronounced, but there was an accompanying increase in the risk of major bleeding with invasive treatment that the authors warned doctors to be aware of.

What it means to you: Physicians tend to be reluctant to use invasive procedures on older patients because their bodies can be more fragile and they are often at higher risk for complications. Thus, treatment for less severe heart attacks has often followed the conservative approach. However, this study, Bach says, "comes out in favor of what I think would be a change in [doctors'] practice." He hopes that doctors take this study to heart and consider changing the way they treat older patients with heart disease.

Caveats: Patients with other diseases in addition to heart disease were excluded from this study. So the population may have been healthier than a general group of people with heart disease, probably making them less likely to have another heart attack or die from coronary disease.

Find out more: The American Heart Association has a good explanation of exactly what happens to your heart when you have a heart attack.

The Cleveland Clinic, a hospital, has a page with information about various treatments for a heart attack.

Read the article: Bach, R. G. et al. "The Effect of Routine, Early Invasive Management on Outcome for Elderly Patients With Non-ST Segment Elevation Acute Coronary Syndromes." Annals of Internal Medicine. Aug. 3, 2004, Vol. 141, No. 3, pp. 186-195.

Abstract online: http://www.annals.org