Ageism in cardiology

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Abstract
Evidence The ageing of the population is one of the major challenges facing health services. The growing number of older people is likely to place increasing demands on health services for access to effective health technology in cases in which this can enhance the quality, not just the quantity, of life. There is some evidence that age has been used as a criterion in allocating health care3 and in inviting participation in screening programmes.4 However, the idea that a patient's age may be used as an explicit basis for priority setting has rarely been acknowledged.5 Cardiovascular diseases are a common cause of death and disability among older people, and the use of appropriate health technologies for diagnosis and treatment is expensive. Despite the slightly higher risks of perioperative mortality and morbidity in older people, if they are selected appropriately they are likely to gain substantial health benefits from cardiological interventions. 1 6 7 Ironically, although cardiac surgeons are increasingly operating on people aged 75 and older, analyses in Europe and the United States which examined both the rates and types of interventions used indicate that age biases exist in cardiology. The argument presented here—that ageism exists in health care—uses research on the equity of access to cardiological services. Rates of potentially life saving and life enhancing cardiological interventions, such as revascularisation, have been reported to vary widely by country, ethnic group, place of residence, economic activity (that is, whether someone is in paid employment), sex, and age.8–13 Higher rates of intervention occur among younger people than among older people, despite the prevalence of cardiovascular disease being considerably higher among the latter group. Older people, and older women in particular, are less likely to receive appropriate cardiological investigations—from echocardiography to measuring cholesterol concentrations.14 Older people are more likely to have more severe disease and to be treated medically rather than surgically, 15 16 and they are less likely to receive the most effective treatment after acute myocardial infarction.17 They receive thrombolytic treatment less often than younger people, even in the absence of contraindications.18–20 The effects of age on access to health care occur independently of sex.