Author: Ksenia Eruslanova
Origin/Afiliation: Kseniia Eruslanova, MD, MSc. Russian clinical and research geriatric center
“Quality of life is important, at least when you are alive”. This phrase was mentioned several times in a cardiology congress, when doctors talked about ISCHEMIA trial results (the study was published in 2019 and divided the cardiology world in two: in part, stenting is good for stable patients or stenting is useless. People who support stenting appeal to quality of life, which is significantly better with procedure). But sometimes, patients who need less pain do not get stenting… because they are too old.
A few months ago, my colleagues asked me to help a patient. She was 81 years old with severe angina pectoralis (pain with minimal physical activity. Even walking from one room to another causes pain). Recently, she got angiography, which found triple vessel disease. Due to her comorbidity, she was not a candidate for open surgery, and her attempt to perform stenting in a rural hospital was unsuccessful. Moreover, to increase antianginal therapy was impossible due to hypotension. Doctor's advice was tried to adapt to living with this pain.
I refer patients to one of the specialized cardiology centers. Surgeons in these centers know almost nothing about geriatric medicine in general and complex geriatric assessment in particular. But they never refuse to help older adults to fix their coronary or valve problems. One of them is my medical school classmates. Sometimes he asked me: “why do internal medicine/family doctors refuse to send patients to them? It is their specialty to help these patients”. And I do not know the answer. I do not know why somebody could say: “what do you want? Do you know your age?”. Maybe because I have so long (almost 5 years) studied medicine in the USA) and I strongly believe that patients should be fully informed about their diagnosis and possible treatment (with all risks and benefits) and the final decision should be made by patients, not by doctors or family (when we talk about patients without cognitive impermeant). At least in cardiology, nowadays we have multiple opportunities to help our patients, even if sometimes we cannot improve life expectancy, we can definitely improve quality of life.
The patient received a new stenting procedure, which was successful. She came to my clinic 1 month after that with her daughter. She was very happy, she could now move not only into her apartment without pain, but she could also go outside: to go with her daughter to a supermarket or a social center for older adults without any pain. Maybe it increases her bleeding risk for the next 6 months, but it defiantly improves her quality of life and makes her happy.
PS. Maybe we should not have ageing as diagnosis in ICD 11? Because age by itself very rare make sense… (it is my personal opinion)