Ann Thorac Surg 1996;62:449
© 1996 The Society of Thoracic Surgeons
Review of Recent Books
Review of Recent Books
Coronary Bypass Surgery in the Elderly. Ethical, Economical and Quality of Life Aspects
Agustin Arbulu, MD
This book is a compilation of the papers presented at an international symposium where world experts in health economics, ethics, clinical cardiology, cardiac surgery, epidemiology, and health care policy discussed the need and outcome of the operation in old and very old patients. The meeting took place from March 9 to 11, 1994, in Antwerp, Belgium.
The book is divided into six parts. In part I, the demographics and health policy are presented in relation to the economic trends in Europe. The increase of the elderly within a range of 24% to 64% by the year 2020 will raise the prevalence of coronary disease. This elderly segment will need intervention techniques such as coronary artery bypass grafting and percutaneous transluminal coronary angioplasty more than ever. In part II, the results of coronary bypass grafting are presented in a series of four papers. These presentations confirm the fact that the elderly tolerate coronary bypass operations almost as well as patients who are less than 65 years of age. For the great majority of elderly patients (octagenarians) the quality of life is vastly improved by a coronary operation. In part III, the cost of coronary bypass grafting is carefully analyzed in a paper from Germany that concludes that the average costs per heart operation of younger patients are slightly lower than the corresponding costs for older patients. In part IV, the controversies in relation to economic and ethical questions related to the surgical management of the elderly are discussed. Most of the viewpoints presented are based on the philosophical considerations of the authors of the five papers presented. In part V, which I consider perhaps the most revealing of the whole book, the influence of coronary bypass grafting on the quality of life for the elderly patient is carefully studied in six presentations. Three of these papers were from the United States. It appears that the improvement in the quality of life is a result of great importance among the elderly, far more important than survival rates. Finally, in part VI, the characteristics of the rehabilitation of the elderly are discussed. This area is often neglected and in need of improvement. The book closes with discussions that developed during the proceedings of the symposium. This portion of the book is quite interesting and very informative.
I consider the book to be valuable to primary doctors, internists, cardiologists, cardiac surgeons, health care officers, administrators, and economists of the health care industry. The book is timely as we enter the era of various managed care systems in health care.
Detroit, Michigan
