European Heart Journal Advance Access originally published online on January 27, 2009
European Heart Journal 2009 30(8):987-994; doi:10.1093/eurheartj/ehn601
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Changes in management of elderly patients with myocardial infarction
Department of Cardiology, University Hospital Jean-Minjoz, Université de Franche Comte, EA 3920 Boulevard Fleming, 25000 Besançon, France
Received 26 May 2008; revised 31 October 2008; accepted 22 December 2008; online publish-ahead-of-print 27 January 2009.
* Corresponding author. Tel: +33 381 668 539, Fax: +33 381 668 582, Email: francois.schiele{at}univ-fcomte.fr
See page 887 for the editorial comment on this article (doi:10.1093/eurheartj/ehp117)
Aims: Despite being at higher risk for mortality, elderly patients (
75 years) admitted for acute myocardial infarction (MI) often receive fewer effective therapies, because of contraindications or higher risk of drug-induced adverse events. The aim of this study was to assess the changes in the use of effective treatments between 2001 and 2006 in elderly patients, and the relation with 1-month mortality.
Methods and results: Prospective, multicentre registry, considering two periods: 6 months between October 2000 and March 2001 (cohort 1) and 12 months between October 2005 and October 2006 (cohort 2). Demographic and clinical characteristics at admission, in-hospital treatment (reperfusion or early invasive therapy, oral antiplatelets, anticoagulants, angiotensin-converting enzyme (ACE)-inhibitors, beta-blockers, and statins), and 1-month survival were compared between the two cohorts, after adjustment on a propensity score (for being admitted in 2001). Eight hundred and sixty-eight elderly patients were included, 280 in cohort 1 and 588 in cohort 2. When compared with cohort 1, patients from cohort 2 presented with comparable characteristics, except for the Global Registry of Acute Coronary Events risk score and we observed a significant increase in the use of aspirin, clopidogrel, reperfusion therapy, ACE-inhibitors, and statins in cohort 2. One-month mortality was significantly lower in cohort 2 (13.6% in cohort 1 vs. 7.1% in cohort 2, P = 0.001), mainly driven by a decrease in the mortality among patients with ST-segment elevation MI (23.3% in cohort 1 vs. 9.2% in cohort 2, P < 0.001). Adjustment on the propensity score did not alter these results. By multivariable analysis, the three-fold higher mortality in patients from cohort 1 was offset when the rate of use of treatments was considered in the model, suggesting that the treatment intensity was related to lower mortality.
Conclusion: Between 2001 and 2006, a significant increase in the use of guidelines-recommended treatments (GRTs) was observed, associated with lower 30-day mortality, in elderly patients. These data confirm that high-risk patients, such as the elderly, benefit from an increase in the use of GRTs.
Key Words: Elderly • Quality of care • Acute myocardial infarction • Guidelines
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