Should an 82 year old man with CHF, CKD and diabetes get a heart stent?

This article in current AARP publication discusses problems with stints. It’s primarily about how stints don’t prevent heart attacks for patients with stable angina. At the end of the article they mention several problems that the stints can cause. One of the problems being the one already mentioned about the kidneys.

www.aarp.org/health/conditions-treatments/info-2018/stents-effectiveness-fd.html

It seems your dad hasn’t quite understood what certain procedures can and cannot do. My dad is very much the same. Because the doctor prescribed him Symbicort, which over a month or two would allow him to breath easier, the inhaler didn’t return him to breatheing like a 25 year old, he threw the medicine away and declared it ‘useless’.

Your dad’s not going to be happy with the stent outcome and the surgery could overwhelm what body functions he has left.

Ask dad if he is willing this experiment to end his life soon? My dad’s 89 but he’s not that brave.

Stents are often overused, because they often fail in the long run. Studies have shown that use of medications is just as good, if not better than stenting for most patients. Books I recommend to everyone are Rethinking Aging and Worried Sick both by Dr. Nortin Hadler.

IMO, cardiologists  are way too aggressive in recommending surgical options when medication is usually the safer route and just as effective. In the case of an elderly patient with so many conditions, it sounds like his doctor is being appropriately cautious. 

tperri, wow, the one doc was ready to do emergency surgery to remove my dad's gallbladder - guess you could truly emergency, this was when he'd been taken to the er - maybe this is why you should have these decisions made ahead of time but as far as we know he hadn't been having problems; had he and just couldn't express it or didn't know and we didn't recognize till that felt needed to take him to er - so anyway while we were trying to decide - so what do you do; how do you decide - they changed shifts and the next doctor wouldn't even do it, based on his heart condition - his CHF? - not sure but didn't matter that we'd decided we'd have it done, wouldn't do it, so then what

I certainly hope when I get to an advanced age no one is going to operate on ME. I have no one to care, so it's a moot point - except one relative. And I have expressed my wishes to receive comfort care, no heart operations, transplants, or any other tomfoolery that will extend my life for no purpose. When it's time, it's time!

Something else to consider is his overall conditioning. Does he exercise regularly? When my Dad was 82, he had a series of heart attacks. He also had CHF, CKD and bleeding ulcers. The docs said he needed a stent, but didn't think he'd survive long afterward.

Dad had been an exercise freak all of his life. At that point he was exercising about 45 minutes per day. Dad wanted the stent and I believed that the docs were underestimating his conditioning. Next week, Dad will be 97 years old. I attribute his longevity to his conditioning, which he keeps up to this day.

Nikki850:

That's such a tough decision because of the kidney issue.

There is an alternative to a stent procedure that is non invasive.

It is called: Enhanced external counterpulsation (EECP)

Below is a link to an article describing it and a portion of the article.

From the link: "Enhanced external counterpulsation (EECP) is a safe, non-invasive procedure that can overcome heart disease in two ways—by passively exercising the heart to strengthen the vascular system and by targeting inflammation, the underlying culprit in damaged blood vessels that inhibits blood flow. "
lifeextension.com/magazine/2008/6/Doctors-Ignore-Alternative-To-Coronary-Stents-Bypass-Surgery/Page-01

NO, and do not take any medical practitioners advice for him to do so. The Dr should pass on any conceived payment he might receive for even stating such a treatment plan for a man of this age. Get three, not another, but three additional opinions! Dr Coppertino

My Mom had one kidney working half capacity and they wouldn't do a dye test. I agree, you need a sit down with the doctors. If Dad wants it done, that is his decision.

My husband is 86 and needed to have his gallbladder removed. His primary said he wouldn't do it because of his age but my husband was always ill after meals no matter what he ate. It was his decision so he had his GB removed and he has had no stomach issues since. My husband also is short of breath, couldn't have a stent and had to have open heart surgery to correct the problem. I would get a second opinion on the kidney disease. I am assuming he has a cardiac MD and a doctor for his kidney problem. I would investigate all the physicians in regards to his medical problems then weigh the problem. I wouldn't rely on just one MD.

My dad's cardiologist just wouldn't do it, not that he could, or the hospital where he was, so we could possibly have had him transferred, but he explained the risks, though not in quite as much detail as above, but dad had not, overall anyway, complained of any heart issues, no shortness of breath, didn't even know anything about any of it; it was discovered in routine bloodwork, with elevated cardiac enzymes, that he must have had a heart attack that nobody knew about and at the time he wasn't really in a position to tell us; we found out later what must have happened, not really sure why was handled the way it was, learned that his "caregiver"; well, not really, family member technically was but they had somebody with them - a long story - but they're the ones who found him and didn't tell anybody, just got him back to bed - if I think about it too much I want to cry - was he in pain, don't think I even thought about it at the time - but then the next day the family member found him collapsed, I guess so, how much of that was behind everything and what should have been done - I know he'd told me for years he would just like to go that way, like other members of his family, so maybe he should have been allowed to, something we never actually thought about or really knew how to handle, maybe a DNR, not sure ever really thought about it all the times he would say that, he didn't know what they were, and guess when did think just hoped it wouldn't be necessary, that it wouldn't be a halfway thing, it would just be done, and maybe if hadn't been found, maybe it was deliberate that others weren't? does the coroner have a way of knowing? hm...but this family member wouldn't have been able to bring himself, maybe in time, maybe he should have talked to him more, again, hm....anyway, cardio's take, also possibly because kidney issues had been found as well, not sure if knew that, but should have at least been on his chart and he was knew and seemed rather thorough, so...still not sure really understand but he was put on a blood building shot - for his kidney? issue - and learned, but not till later, he was diagnosed with chronic kidney disease, thinking the shot wasn't really working? at least not like they hoped when they discovered he hadn't already had it, so how does that happen? anyway, also learned after discharge he'd also been dx'd with CHF that we didn't know about but according to nurse a different kind, not so much affecting his as his extremities so not sure how that would apply, but can see be somewhat different, but at least at the time, unless sedated, he wouldn't have lay still, so, no, to answer your question, we didn't do stent but he was also 10 yrs. older, too; he did have a surgery at that age - that we didn't think he should have had to have, not because of his age, but because he'd already had it and didn't think was supposed to come up again, but oh well, but he made it through that fine - another situation just learned about man in his 70s didn't have it and had another 10 yrs. of good quality of life even though docs said he'd only have a year at the most, so...

My dad had the congestive heart and the beginnings of kidney problems (he later went onto dialysis) - but he had the stent put in and it helped immensely. I can remember him being so surprised that the pain was gone! He said it was the first time he could remember without chest pain.

My dad was also 82 at the time and he lived until 88 when he decided to stop the dialysis after 3+ years.

Doctors can let you know what the risks are, but often cannot really predict an outcome when someone has multiple health issues. If successful, a stent may relieve his shortness of breath and give a better quality of life and/or a longer life. Or the procedure may kill him. Last week a family member in his 80s with multiple health issues, including kidney problems, had surgery against the advice of his primary doctors who had told him it was too risky. He found a surgeon who was willing to do the knee replacement and he made it through the surgery well, but then went into kidney failure during recovery and died. He knew the risks and had decided he wanted out of his knee pain - either the surgery would work and he would walk again or death would free him from the pain. Many people would say my family member made the wrong choice. I don't agree. When someone has already enjoyed a long life, I support his/her choice to risk the length of days for the chance to have more quality days. I would encourage you to make sure your father has all the information to make a fully informed choice and then support his decision. Although the decision may be difficult, I don't think there are any wrong choices here.

nikki, this is heartbreaking. Constant shortness of breath is certainly a big driving factor. I’d get 2nd and 3rd opinions. I hope others with some experience will see this. Good luck.

My dad is 81 and he has the same conditions and he did ,,I’m a RN and everyone is different ..I’d speak with the drs and see what they say

They will NOT do a kidney transplant in someone so old. It's simply--not done.

You have to weigh out the positives and negatives--while the stent is done under "light sedation" it isn't terribly risky. But if your dad is non compliant with the procedure's aftermath (lying still on your back for quite a long time---) could he do that?

QOL at this age is far more important than trying to "fix" all the ailments of aging as they show up.

Could you have this kind of discussion with his doctors?

In the best case, how long is Dad likely to live if nothing is done?
If it is successful, how long is Dad likely to live after a stent placement?

Then ask about quality of life in each situation. The CKD is not likely to be improved by a stent. How big is the influence of that condition on his quality of life?

Bumping this up.