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.
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.
Authors: Jennifer Tjia; Jeroan Allison; Jane S Saczynski; Mayra Tisminetzky; Jane L Givens; Kate Lapane; Darleen Lessard; Robert J Goldberg Journal: Am J Med Date: 2013-07-05 Impact factor: 4.965
Authors: Emily M Bucholz; Neel M Butala; Sharon-Lise T Normand; Yun Wang; Harlan M Krumholz Journal: J Am Coll Cardiol Date: 2016-05-24 Impact factor: 24.094
Authors: Petr Kala; Jan Kanovsky; Richard Rokyta; Michal Smid; Jan Pospisil; Jiri Knot; Filip Rohac; Martin Poloczek; Tomas Ondrus; Maria Holicka; Jindrich Spinar; Jiri Jarkovsky; Ladislav Dusek Journal: BMC Cardiovasc Disord Date: 2012-04-25 Impact factor: 2.298
Authors: Leonardo De Luca; Zoran Olivari; Leonardo Bolognese; Donata Lucci; Lucio Gonzini; Antonio Di Chiara; Gianni Casella; Francesco Chiarella; Alessandro Boccanelli; Giuseppe Di Pasquale; Francesco M Bovenzi; Stefano Savonitto Journal: Open Heart Date: 2014-12-13
Authors: Marcus D Flather; Jean Booth; Daphne Babalis; Hector Bueno; Philippe G Steg; Grzegorz Opolski; Filippo Ottani; Jacques Machecourt; Alfredo Bardaji; Mats Bojestig; Anthony R Brady; Bertil Lindahl Journal: Trials Date: 2010-01-14 Impact factor: 2.279