Albert Ariza-Solé1, Oriol Alegre1, Francisco J Elola2,3, Cristina Fernández3,4, Francesc Formiga1, Manuel Martínez-Sellés5, José L Bernal3,6, José V Segura3,7, Andrés Iñíguez2,8, Vicente Bertomeu2,9, Joel Salazar-Mendiguchía1, José C Sánchez Salado1, Victòria Lorente1, Angel Cequier1,2. 1. 1 Hospital Universitario de Bellvitge, Universidad de Barcelona, Spain. 2. 2 Sociedad Española de Cardiología, Guadalupe, Madrid, Spain. 3. 3 Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain. 4. 4 Hospital Clínico Universitario San Carlos. Universidad Complutense de Madrid, Spain. 5. 5 Hospital General Universitario Gregorio Marañón, Universidad Complutense, Universidad Europea, Madrid, Spain. 6. 6 Control Management Service, 12 de Octubre Hospital, Madrid, Spain. 7. 7 IUI Operative Research Centre, Miguel Hernández University, Alicante, Spain. 8. 8 Hospital Alvaro Cunqueiro, Vigo, Spain. 9. 9 Hospital Universitario de San Juan, Alicante, Spain.
Abstract
BACKGROUND: We aimed to assess the impact of implementation of reperfusion networks, the type of hospital and specialty of the treating physician on the management and outcomes of ST segment elevation myocardial infarction in patients aged ⩾75 years. METHODS: We analysed data from the Minimum Basic Data Set of the Spanish public health system, assessing hospital discharges between 2004 and 2013. Discharges were distributed in three groups depending on the clinical management: percutaneous coronary intervention, thrombolysis or no reperfusion. Primary outcome measure was all cause in-hospital mortality. For risk adjustment, patient comorbidities were identified for each index hospitalization. RESULTS: We identified 299,929 discharges, of whom 107,890 (36%) were in-patients aged ⩾75 years. Older patients had higher prevalence of comorbidities, were less often treated in high complexity hospitals and were less frequently managed by cardiologists ( p<0.001). Both percutaneous coronary intervention and fibrinolysis were less often performed in elderly patients ( p<0.001). A progressive increase in the rate of percutaneous coronary intervention was observed in the elderly across the study period (from 17% in 2004 to 45% in 2013, p<0.001), with a progressive reduction of crude mortality (from 23% in 2004 to 19% in 2013, p<0.001). Adjusted analysis showed an association between being treated in high complexity hospitals, being treated by cardiologists and lower in-hospital mortality ( p <0.001). CONCLUSIONS: Elderly patients with ST segment elevation myocardial infarction are less often managed in high complexity hospitals and less often treated by cardiologists. Both factors are associated with higher in-hospital mortality.
BACKGROUND: We aimed to assess the impact of implementation of reperfusion networks, the type of hospital and specialty of the treating physician on the management and outcomes of ST segment elevation myocardial infarction in patients aged ⩾75 years. METHODS: We analysed data from the Minimum Basic Data Set of the Spanish public health system, assessing hospital discharges between 2004 and 2013. Discharges were distributed in three groups depending on the clinical management: percutaneous coronary intervention, thrombolysis or no reperfusion. Primary outcome measure was all cause in-hospital mortality. For risk adjustment, patient comorbidities were identified for each index hospitalization. RESULTS: We identified 299,929 discharges, of whom 107,890 (36%) were in-patients aged ⩾75 years. Older patients had higher prevalence of comorbidities, were less often treated in high complexity hospitals and were less frequently managed by cardiologists ( p<0.001). Both percutaneous coronary intervention and fibrinolysis were less often performed in elderly patients ( p<0.001). A progressive increase in the rate of percutaneous coronary intervention was observed in the elderly across the study period (from 17% in 2004 to 45% in 2013, p<0.001), with a progressive reduction of crude mortality (from 23% in 2004 to 19% in 2013, p<0.001). Adjusted analysis showed an association between being treated in high complexity hospitals, being treated by cardiologists and lower in-hospital mortality ( p <0.001). CONCLUSIONS: Elderly patients with ST segment elevation myocardial infarction are less often managed in high complexity hospitals and less often treated by cardiologists. Both factors are associated with higher in-hospital mortality.