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COSTLY SURGERY DOWNPLAYED IN HEART STUDY

More older heart attack victims could be saved by expert care immediately following their illness than by coronary bypass surgery, angioplasty or other expensive medical procedures, a new study says.

Elderly patients treated at hospitals with coronary care units are more likely to survive four or more years after their heart attacks than those without access to specialized care, according to the study in this week's Journal of the American Medical Association.But surgery or angioplasty days or weeks following heart attacks in older people make little difference in their overall survival rates, the Harvard Medical School study of 205,000 Medicare patients who had suffered heart attacks in 1987 found.

In fact, the study concludes that invasive procedures such as cardiac catheterization - using X-rays and blood pressure measurements to determine how much blood clogged arteries are bringing to the heart - could be reduced by 25 percent without resulting in more deaths.

But such a reduction would translate into cost savings, the study said. The issue of whether older heart attack victims should get the same kind of aggressive treatment - including surgery and angioplasty - as younger people long has been debated.

The cost of extending such treatment, which often costs thousands of dollars, to the millions of heart attack victims in their 60s and 70s has been cited as one of the forces driving up health-care costs.

Instead of increasing the number of surgeries and invasive procedures for elderly victims, emergency coronary-care services should be made more available in rural areas and at smaller hospitals, the researchers said.

The study also found that older female heart attack victims are treated less aggressively than older white men.

This is in keeping with past studies, which have shown that men are more likely to receive angioplasty and surgery than women even though more women die from heart disease.

Other studies have shown that older blacks have been denied access to expensive procedures such as angioplasty afforded to more older whites. The reasons given have included everything from poverty to racism.