Trends in Management, Hospital and Long-Term Outcomes of Elderly Patients With Acute Myocardial Infarction

Am J Med. 2007 Jan;120(1):90-7. doi: 10.1016/j.amjmed.2006.09.018.

Abstract

Purpose: The number of elderly patients with acute myocardial infarction (AMI) is growing rapidly, and their early and postdischarge mortality is high. Several studies have reported a decline in mortality after myocardial infarction; however, the magnitude of the decline among the elderly has not been fully investigated.

Methods: We assessed trends in management, in-hospital, and long-term outcomes of 1475 elderly patients (aged > or =75 years, 42% women) hospitalized with AMI in all 25 operating coronary care units in Israel between 1992 and 2002, from our prospective nationwide biennial surveys.

Results: Between 1992 and 2002, a significant increase was observed in the use of acute reperfusion therapy (27%-48%), coronary angiography (6%-47%), percutaneous coronary intervention (3%-33%), coronary bypass (2%-8%), aspirin (53%-88%), beta-blockers (18%-65%), angiotensin-converting enzyme inhibitors (26%-63%), and lipid-lowering drugs (0%-43%). These changes were associated with a 42% reduction in 30-day mortality (27.6%-16.1%; adjusted odds ratio 0.57; 95% confidence interval [CI], 0.36-0.93). One-year cumulative mortality declined by 20% (37%-29%; adjusted odds ratio 0.74; 95% CI, 0.49-1.13).

Conclusions: The management of elderly patients with AMI changed substantially during the last decade. This change was associated with a significant reduction in early mortality, whereas cumulative 1-year mortality improved only slightly. Better adherence to in-hospital management guidelines and better implementation of postdischarge health policy may further decrease mortality and morbidity in the elderly after AMI.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Israel / epidemiology
  • Logistic Models
  • Male
  • Myocardial Infarction / mortality
  • Myocardial Infarction / therapy*
  • Outcome and Process Assessment, Health Care*
  • Prospective Studies
  • Registries
  • Survival Rate