80 not the new 70: Age may bias heart care, study finds

NEW YORK, Feb 23, (AP): People are more likely to buy things when prices end in 99 cents rather than rounded up to the next dollar, or cars with mileage under 1,000 instead of past that mark. Now researchers say something similar might be happening with age perception and heart surgery.

A US study out last Wednesday finds that heart attack patients who turned 80 within the previous two weeks were less likely to get bypass surgery than those who were two weeks shy of that birthday, even though the age difference is less than a month.

Guidelines do not limit the operation after a certain age, but doctors may be mentally classifying people as being “in their 80s” and suddenly much riskier than those “in their 70s”, said the study leader, Dr Anupam Jena of Harvard Medical School.

The reason may be “left-digit bias,” or the tendency to focus on the first number.

“When you go to a store and the item is $4.99 you’re more likely to buy it than if it’s $5,” but there’s no similar effect when prices are $4.50 versus $4.51, Jena said.

“That penny matters more when you’re crossing a threshold” to a new dollar amount, he said.

It poses a serious concern in health care. Although a less invasive treatment, an arteryopening stent procedure, is often the treatment for a heart attack, bypass surgery is preferred when many arteries are affected or in some other situations.

Option

To see if left-digit bias affects who is offered that option, researchers studied Medicare records from 2006 through 2012 on 70,000 heart attack patients, including about 10,000 within two weeks of their 80th birthday. They found that 5.3% of the just turned 80 group had bypass surgery versus 7% of those slightly younger.

They also looked at other birthdays, such as 77 versus 79 and 81 versus 83 and saw no difference in rates, suggesting that crossing 80 was a key mark.

Death rates during the first two months after the heart attack were higher among those over 80, suggesting they might have been harmed by not being offered surgery, Jena said.

The New England Journal of Medicine published the work.

It can’t prove that mental bias is affecting surgery rates but an independent expert, Dr John Spertus, director of health outcomes research at Saint Luke’s Mid America Heart Institute in Kansas City, Missouri, says it makes a strong case.

“I believe that these types of cognitive biases are rampant in medical decision-making and this is a very clear demonstration of the phenomenon,” he said.

Spertus has developed risk assessment tools that rely on more objective factors to guide care.

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Flu: It may end up being a bad flu season for kids, but early signs suggest the vaccine is working OK.

The vaccine has been more than 50% effective in preventing flu illness severe enough to send a child to the doctor’s office, the US Centers for Disease Control and Prevention said Thursday. Health experts consider that pretty good.

The vaccines are made each year to protect against three or four different kinds of flu virus. The ingredients are based on predictions of what strains will make people sick the following winter. It doesn’t always work out.

This flu season has featured two waves, each dominated by a different virus. Both of those flu bugs are considered dangerous to children, but tend not to be as dangerous to the elderly.

Strain

Health officials grew worried when it became clear that the vaccine didn’t match the Type B flu strain that ended up causing most early season illnesses. But the CDC estimates that the vaccine has been about 50% effective against that strain in children.

And the vaccine has been about 55% effective among kids against the Type A strain that has caused a second wave of flu illnesses.

“These estimates are reassuring,” said the CDC’s Brendan

Flannery, who oversees the agency’s system for evaluating the vaccine.

Vaccines against many infectious diseases aren’t considered successful unless they work at least 90% of the time. But flu is particularly challenging, partly because the virus can so quickly change. Overall, flu vaccine averages around 40%.

This season, the vaccine has been 45% effective against both types of flu across all ages.

That can change as the flu season progresses. Updated vaccine numbers are expected later this year.

One troubling finding: This season’s vaccine has been virtually ineffective vs. the Type A virus in younger adults. The reason is a mystery, but may change as more data comes in, Flannery said.

US health officials have counted 92 child flu deaths this year, up from the same time last year but fewer than were counted by this point in 2018. In all, the CDC estimates at least 14,000 Americans have died of the flu this season.