University of Massachusetts Medical School Faculty Publications

Title

Characteristics, treatment practices, and in-hospital outcomes of older adults hospitalized with acute myocardial infarction

UMMS Affiliation

Department of Quantitative Health Sciences; Meyers Primary Care Institute; Department of Medicine, Division of Cardiovascular Medicine

Date

8-1-2014

Document Type

Article

Medical Subject Headings

Age Factors; Aged; Aged, 80 and over; Female; *Hospitalization; Humans; Length of Stay; Male; Myocardial Infarction; Physician's Practice Patterns; Retrospective Studies; Risk Factors; Treatment Outcome

Disciplines

Cardiology | Cardiovascular Diseases | Clinical Epidemiology | Geriatrics | Health Services Research

Abstract

OBJECTIVES: To examine overall and decade-long trends (1999-2009), characteristics, treatment practices, and hospital outcomes in individuals aged 65 and older hospitalized for acute myocardial infarction (AMI) and to describe how these factors varied in the youngest, middle, and oldest-old individuals.

DESIGN: Retrospective cohort study.

SETTING: Population-based Worcester Heart Attack Study.

MEASUREMENTS: Analyses were conducted to examine the sociodemographic and clinical characteristics, cardiac treatments, and hospital outcomes of older adults in three age strata (65-74, 75-84, > /=85).

PARTICIPANTS: The study sample consisted of 3,851 individuals aged 65 and older hospitalized with AMI every other year between 1999 and 2009; 32% were aged 65 to 74, 43% aged 75 to 84, and 25% aged 85 and older. RESULTS: Advancing age was inversely associated with receipt of evidence-based cardiac therapies. After multivariable adjustment, the odds of dying during hospitalization was 1.46 times as high in participants aged 75 to 84 and 1.78 times as high in those aged 85 and older as in those aged 65 to 74. The oldest-old participants had approximately 25% lower odds of a prolonged hospital stay (>3 days) than those aged 65 to 74. Decade-long trends in the principal study outcomes were also examined. Although the oldest-old participants hospitalized for AMI were at the greatest risk of dying, persistent age-related differences were observed in hospital treatment practices. Similar results were observed after excluding participants with a do-not-resuscitate order in their medical records.

CONCLUSION: Although there are persistent disparities in the care and outcomes of older adults hospitalized with AMI, additional studies are needed to delineate the extent to which less-aggressive care reflects individual preferences and appropriate implementation of palliative care approaches.

© 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

Rights and Permissions

Citation: J Am Geriatr Soc. 2014 Aug;62(8):1451-9. doi: 10.1111/jgs.12941. Link to article on publisher's site

Related Resources

Link to Article in PubMed