A clinical trial supported by the National Institute for Health Research (NIHR) will investigate if current UK practices are in line with the needs of our ageing population, by finding the most suitable way to treat patients aged 75 and over who have had a heart attack.

Researchers at Newcastle University and the Newcastle upon Tyne Hospitals NHS Foundation Trust have received £1.7million from the British Heart Foundation to lead the clinical trial.

Biggest Killer

Coronary Heart Disease (CHD) is the UK’s single biggest killer and the leading cause of death worldwide. CHD is responsible for nearly 70,000 deaths in the UK each year and most of these deaths are caused by a heart attack.

Although there have been advances in how CHD is treated, little research has been carried out to look at how best to treat patients over 75 years old despite the fact that 50% of heart attacks happen in patients aged 72 and over.

Dr Vijay Kunadian, Senior Lecturer at Newcastle University and Honorary Consultant Interventional Cardiologist at Newcastle’s Freeman Hospital is the chief investigator responsible for the clinical trial across the country.

Dr Kunadian said: “There is much debate and conflicting views amongst clinicians and cardiologists about how to treat patients over 75 years old who present with a heart attack due to lack of definitive evidence as older patients are often excluded from clinical research.

“As people are now living longer and longer it's really important we carry out this research to identify how best to treat these patients to ensure they receive the best care available and enhance their chances of survival.”

Currently 86% of older patients (85 and over) who have a heart attack are given medication to treat their condition rather than combined treatment involving medication and a procedure known as a coronary angioplasty, which clears blockages in the heart arteries using a balloon and a metal scaffold, known as a stent. This is compared to 17% of patients aged 18 to 65 years old demonstrating huge disparity in treatments based on age.

Many clinicians believe older patients are frail, have a lower chance of survival and are more likely to have complications after heart procedures, however this is based purely on perception rather than evidence based research. 

Clinical trial

The clinical trial will look to determine whether patients over the age of 75 will benefit from a coronary angiography and angioplasty after having a minor heart attack. Patients on the trial will be randomised to have either the procedure alongside medication or receive medication in keeping with the current practice.

Brian Thompson, an 83 year old patient from Newcastle had a stent fitted as part of the trial in June this year.

He said: “I had my heart attack in June of this year and I’m very lucky that I’ve been able to carry on with my life with my wife.

“It made sense for me to take part in the trial as it will help doctors make better decisions for patients like me. It has been a good experience dealing with the doctors and research nurses at the Freeman Hospital.

“I’ve also had the opportunity to see my own scans and talk to them about my heart and what we will be doing going forward. It feels good to know that I’m part of something that will help not just people in my generation, but for those in the future as well.”

Newcastle is well placed to host this clinical trial, with ageing research being of a world-renowned standard. The NIHR Newcastle Biomedical Research Centre (BRC) funded a preliminary piece of research led by Dr Kunadian looking at CHD in older people and has led to the development of this nationwide clinical trial.

The NIHR Newcastle BRC focusses on a translational programme of research that builds on and harnesses experimental medicine expertise in individual long-term conditions, advancing the diagnosis, treatment and prevention of ageing syndromes. As a partnership between Newcastle Hospitals and Newcastle University, the focus is on research that can be directly beneficial to the patient.

Professor Avan Sayer, Director of the NIHR Newcastle BRC and Honorary Consultant in Geriatric Medicine at The Newcastle upon Tyne Hospitals NHS Foundation Trust commented: “With the proportion of over 70s on the increase, it is vital that the needs of older people are addressed through dedicated research activity of this kind.   

“We are delighted that Dr Kunadian’s project is being extended and that our NIHR-supported projects across the North East and North Cumbria are being channelled into such a vital area of medicine”. 

Patients Needed

The nationwide trial, known as SENIOR-RITA hopes to find 2,300 patients across 40 different hospitals over a two year period to take part in the trial. The NIHR has used its network to engage with individuals across the NHS to gain support and raise awareness of the clinical trial across the country, and it has helped hospitals to set up and deliver the study in their local area. This has led to more opportunities for patients to take part in the study.

Professor Jeremy Pearson, Associate Medical Director at the British Heart Foundation, said: “This trial marks a landmark study in improving the care of older heart attack patients. Co-ordinating patients, research staff and clinicians across 40 sites is no mean feat and it will help answer important questions that doctors have when deciding whether to treat older, frailer patients with stents or bypasses.

“Treatments can often carry a risk and there is much more to be done to make sure treatments are suitable for every kind of patient. A heart attack still has the power to devastate a person and their family and we need to keep funding research to find the breakthroughs that will make a difference.”

Press release adapted with thanks to the National Institute for Health Research