TY - JOUR
T1 - Quality of acute myocardial infarction care and outcomes in 33,997 patients aged 80 years or older
T2 - Findings from Get with the Guidelines-Coronary Artery Disease (GWTG-CAD)
AU - Medina, Hector M.
AU - Cannon, Christopher P.
AU - Zhao, Xin
AU - Hernandez, Adrian F.
AU - Bhatt, Deepak L.
AU - Peterson, Eric D.
AU - Liang, Li
AU - Fonarow, Gregg C.
N1 - Funding Information:
Deepak L. Bhatt, MD: Bristol Myers Squibb, research grant >$10,000; Eisai, research grant >$10,000; Sanofi Aventis, research grant >$10,000; The Medicines Company, research grant >$10,000; Astra Zeneca, research grant >$10,000.
Funding Information:
Adrian F. Hernandez, MD: Johnson & Johnson/Scios, research grant >$10,000; GSK, research grant $10,000; AstraZeneca, honoraria <$10,000.
Funding Information:
Eric D. Peterson, MD: Schering Plough/Merck, research >$10,000; BMS/Sanofi, research >$10,000; Johnson & Johnson, research grant >$10,000.
Funding Information:
Gregg C. Fonarow, MD: NIH, research grant >$10,000; Novartis, consultant >$10,000.
Funding Information:
Sources of Funding: GWTG-CAD is a program of the American Heart Association and is supported in part by an unrestricted educational grant from Merck/Schering-Plough Pharmaceutical and Pfizer . The analysis of registry data was performed at Duke Clinical Research Institute (Durham, NC), which receives funding from the American Heart Association. The sponsors were not involved in the design, analysis, preparation, review, or approval of this manuscript.
PY - 2011/8
Y1 - 2011/8
N2 - Objectives: To determine the adherence to national guidelines and in-hospital mortality of older patients with acute myocardial infarction (AMI) using a national database. Background: Prior studies have demonstrated that older patients are less likely to receive evidence-based therapies. Methods: Using data from the GWTG-CAD, we examined care and in-hospital outcomes among AMI patients treated at 416 US centers from 2000 to 2009. Evidence-based medical therapy, other quality measures, and in-hospital post-AMI mortality were analyzed. Results: A total of 156,677 patients were included in the study; 21.7% (n = 33,997) were aged ≥80 years, 33.0% (n = 51,773) 65 to 79 years, and 45.3% (n = 70,907) 18 to 64 years. Older patients had higher prevalence of comorbidities compared to younger patients. Overall, compliance with evidence-based medical treatment upon admission and discharge was high, but age-related differences in care were seen for most measures. After multivariate adjustment, the mortality of the patients aged ≥80 years was substantially higher compared to the youngest cohort (adjusted OR 3.4, 95% CI 3.2-3.8, P <.0001). There were substantial improvements in AMI quality measures over time in each age group. Conclusions: Among AMI patients aged ≥80 years, the use of evidence-based therapies was high and significant improvements over time have been observed in a national quality improvement program. Nevertheless, there remain important age-related gaps in care and outcomes, suggesting opportunities exist to improve prognosis in this high-risk population.
AB - Objectives: To determine the adherence to national guidelines and in-hospital mortality of older patients with acute myocardial infarction (AMI) using a national database. Background: Prior studies have demonstrated that older patients are less likely to receive evidence-based therapies. Methods: Using data from the GWTG-CAD, we examined care and in-hospital outcomes among AMI patients treated at 416 US centers from 2000 to 2009. Evidence-based medical therapy, other quality measures, and in-hospital post-AMI mortality were analyzed. Results: A total of 156,677 patients were included in the study; 21.7% (n = 33,997) were aged ≥80 years, 33.0% (n = 51,773) 65 to 79 years, and 45.3% (n = 70,907) 18 to 64 years. Older patients had higher prevalence of comorbidities compared to younger patients. Overall, compliance with evidence-based medical treatment upon admission and discharge was high, but age-related differences in care were seen for most measures. After multivariate adjustment, the mortality of the patients aged ≥80 years was substantially higher compared to the youngest cohort (adjusted OR 3.4, 95% CI 3.2-3.8, P <.0001). There were substantial improvements in AMI quality measures over time in each age group. Conclusions: Among AMI patients aged ≥80 years, the use of evidence-based therapies was high and significant improvements over time have been observed in a national quality improvement program. Nevertheless, there remain important age-related gaps in care and outcomes, suggesting opportunities exist to improve prognosis in this high-risk population.
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U2 - 10.1016/j.ahj.2011.04.017
DO - 10.1016/j.ahj.2011.04.017
M3 - Article
C2 - 21835289
AN - SCOPUS:80051634863
SN - 0002-8703
VL - 162
SP - 283-290.e2
JO - American heart journal
JF - American heart journal
IS - 2
ER -