TY - JOUR
T1 - Cumulative incidence of death and rehospitalization among the elderly in the first year after NSTEMI
AU - Lopes, Renato D.
AU - Gharacholou, S. Michael
AU - Holmes, Dajuanicia N.
AU - Thomas, Laine
AU - Wang, Tracy Y.
AU - Roe, Matthew T.
AU - Peterson, Eric D.
AU - Alexander, Karen P.
N1 - Publisher Copyright:
© 2015 Elsevier Inc. All rights reserved.
PY - 2015/6/1
Y1 - 2015/6/1
N2 - Background Age is associated with outcomes in non-ST-segment elevation myocardial infarction; however, less is known about rehospitalization or death among elderly survivors. We aimed to evaluate mortality and cause-specific rehospitalization rates in this growing population of older adults with ischemic heart disease. Methods We linked 36,711 patients aged ≥65 years who survived an index non-ST-segment elevation myocardial infarction from the CRUSADE registry to Medicare claims data for follow-up. One-year survival estimates were compared by age group - 65-79, 80-84, 85-89, and ≥90 years - and Cox models were used to analyze the association between age and 1-year mortality. Results Death at 1 year increased markedly with age (from 13.3% for 65-79 years to 45.5% for ≥90 years). In contrast, rehospitalization rates at 1 year were similar and high across ages (65-79 years, 52.7%; ≥90 years, 56.5%), with nearly as many noncardiovascular-related as cardiovascular-related rehospitalizations. At 1 year, nonagenarians had substantially higher rates of death with or without preceding rehospitalization and twice the adjusted mortality than the group aged 65-79 years. Conclusions Evolving care delivery models should consider the high mortality in older adults after a non-ST-segment elevation myocardial infarction. Contrary to expectations, rehospitalization rates do not rise substantially with advancing age, and rehospitalization is often for noncardiac diagnoses.
AB - Background Age is associated with outcomes in non-ST-segment elevation myocardial infarction; however, less is known about rehospitalization or death among elderly survivors. We aimed to evaluate mortality and cause-specific rehospitalization rates in this growing population of older adults with ischemic heart disease. Methods We linked 36,711 patients aged ≥65 years who survived an index non-ST-segment elevation myocardial infarction from the CRUSADE registry to Medicare claims data for follow-up. One-year survival estimates were compared by age group - 65-79, 80-84, 85-89, and ≥90 years - and Cox models were used to analyze the association between age and 1-year mortality. Results Death at 1 year increased markedly with age (from 13.3% for 65-79 years to 45.5% for ≥90 years). In contrast, rehospitalization rates at 1 year were similar and high across ages (65-79 years, 52.7%; ≥90 years, 56.5%), with nearly as many noncardiovascular-related as cardiovascular-related rehospitalizations. At 1 year, nonagenarians had substantially higher rates of death with or without preceding rehospitalization and twice the adjusted mortality than the group aged 65-79 years. Conclusions Evolving care delivery models should consider the high mortality in older adults after a non-ST-segment elevation myocardial infarction. Contrary to expectations, rehospitalization rates do not rise substantially with advancing age, and rehospitalization is often for noncardiac diagnoses.
KW - Coronary disease
KW - Death
KW - Long-term outcomes
KW - Myocardial infarction
KW - Non-ST-segment elevation myocardial infarction
KW - Rehospitalization
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U2 - 10.1016/j.amjmed.2014.12.032
DO - 10.1016/j.amjmed.2014.12.032
M3 - Article
C2 - 25660246
AN - SCOPUS:84930354501
SN - 0002-9343
VL - 128
SP - 582
EP - 590
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 6
ER -