OBJECTIVES: To determine whether age-dependent inequalities in care and outcome changed over a 24 year period for patients admitted with a myocardial infarction (MI). METHODS: We examined four age groups (<55, 55-65, 65-75, and >75 years) and treatment and mortality in 14,434 consecutive patients admitted for MI to an intensive coronary care unit from 1985 to 2008. Temporal trend analyses were performed by comparing decades of admission (1985-1990 vs. 1990-2000 vs. 2000-2008). RESULTS: A total of 2040 (14%) of the patients were >75 years of age. Older patients more often were female and less often presented with an ST-segment elevation MI (STEMI). Systematic differences in care were present between the age groups: older patients were less likely to receive evidence-based medical care and reperfusion therapy during the last 24 years, although the differences became smaller over time. In 2000-2008, 30-day (adjusted OR 0.28, 95%CI: 0.23-0.34) and 5-year (adjusted HR 0.61, 95%CI: 0.54-0.68) mortality were lower compared to 1985-1990. These temporal trends were equal across all age groups. Hence, the change in mortality over the 24-year study period is similar among the spectrum of ages. Patients aged <55, 55-65, 65-75, and >75 years had a 20-year mortality of 38, 63, 87 and >95%, respectively. CONCLUSIONS: Older patients with an MI remained less likely to receive evidence-based care during 24 years of observation. Temporal reductions in mortality were similar among all age groups. The application of proven MI therapies to appropriate patients regardless of age may even further improve these outcomes.
OBJECTIVES: To determine whether age-dependent inequalities in care and outcome changed over a 24 year period for patients admitted with a myocardial infarction (MI). METHODS: We examined four age groups (<55, 55-65, 65-75, and >75 years) and treatment and mortality in 14,434 consecutive patients admitted for MI to an intensive coronary care unit from 1985 to 2008. Temporal trend analyses were performed by comparing decades of admission (1985-1990 vs. 1990-2000 vs. 2000-2008). RESULTS: A total of 2040 (14%) of the patients were >75 years of age. Older patients more often were female and less often presented with an ST-segment elevation MI (STEMI). Systematic differences in care were present between the age groups: older patients were less likely to receive evidence-based medical care and reperfusion therapy during the last 24 years, although the differences became smaller over time. In 2000-2008, 30-day (adjusted OR 0.28, 95%CI: 0.23-0.34) and 5-year (adjusted HR 0.61, 95%CI: 0.54-0.68) mortality were lower compared to 1985-1990. These temporal trends were equal across all age groups. Hence, the change in mortality over the 24-year study period is similar among the spectrum of ages. Patients aged <55, 55-65, 65-75, and >75 years had a 20-year mortality of 38, 63, 87 and >95%, respectively. CONCLUSIONS: Older patients with an MI remained less likely to receive evidence-based care during 24 years of observation. Temporal reductions in mortality were similar among all age groups. The application of proven MI therapies to appropriate patients regardless of age may even further improve these outcomes.
Authors: Joon Seok Choi; Min Jee Kim; Yong Un Kang; Chang Seong Kim; Eun Hui Bae; Seong Kwon Ma; Young-Keun Ahn; Myung Ho Jeong; Young Jo Kim; Myeong Chan Cho; Chong Jin Kim; Soo Wan Kim Journal: Clin J Am Soc Nephrol Date: 2013-02-21 Impact factor: 8.237
Authors: S Nielsen; L Björck; J Berg; K W Giang; T Zverkova Sandström; K Falk; S Määttä; A Rosengren Journal: BMJ Open Date: 2014-05-02 Impact factor: 2.692
Authors: Gerhard Sulo; Jannicke Igland; Stein Emil Vollset; Ottar Nygård; Marta Ebbing; Enxhela Sulo; Grace M Egeland; Grethe S Tell Journal: J Am Heart Assoc Date: 2016-01-07 Impact factor: 5.501