Impact of age on management and outcome of acute coronary syndrome: observations from the Global Registry of Acute Coronary Events (GRACE)
Center for Outcomes Research; Department of Medicine, Division of Cardiovascular Medicine
Adult; Age Factors; Aged; Aged, 80 and over; Angina, Unstable; Angioplasty, Balloon, Coronary; Coronary Artery Bypass; Female; Hospital Mortality; Humans; Male; Middle Aged; Myocardial Infarction; Outcome Assessment (Health Care); Registries; Thrombolytic Therapy
Health Services Research
BACKGROUND: Evidence-based cardiac therapies are underutilized in elderly patients. We assessed differences in practice patterns, comorbidities, and in-hospital event rates, by age and type of acute coronary syndrome (ACS).
METHODS: We studied 24165 ACS patients in 102 hospitals in 14 countries stratified by age.
RESULTS: Approximately two-thirds of patientswere men, but this proportion decreased with age. In elderly patients (> or = 65 years), history of angina, transient ischemic attack/stroke, myocardial infarction(MI), congestive heart failure, coronary artery bypass graft (CABG) surgery, hypertension or atrial fibrillation were more common, and delay in seeking medical attention and non-ST-segment elevation MI were significantly higher. Aspirin, beta-blockers, thrombolytic therapy, statins and glycoprotein IIb/IIIa inhibitors were prescribed less, while calcium antagonists and angiotensin-converting enzyme inhibitors were prescribed more often to elderly patients. Unfractionated heparin was prescribed more often in young patients, while low-molecular-weight heparins were similarly prescribed across all age groups. Coronary angiography and percutaneous intervention rates significantly decreased with age. The rate of CABG surgery was highest among patients aged 65-74 years (8.1%) and 55-64 years (7.7%), but reduced in the youngest (4.7%) and oldest (2.7%) groups. Major bleeding rates were 2-3% among patients aged < 65 years, and > 6% in those > or = 85 years. Hospital-mortality rates, adjusted for baseline risk differences, increased with age (odds ratio: 15.7 in patients > or = 85 years compared with those < 45 years).
CONCLUSIONS: Many elderly ACS patients do not receive evidence-based therapies, highlighting the need for clinical trials targeted specifically at elderly cohorts, and quality-of-care programs that reinforce the use of such therapies among these individuals.
DOI of Published Version
Am Heart J. 2005 Jan;149(1):67-73. Link to article on publisher's site
American heart journal
Avezum A, Makdisse M, Spencer FA, Gore JM, Fox KA, Montalescot G, Eagle KA, White K, Mehta RH, Knobel E, Collet J, GRACE Investigators. (2005). Impact of age on management and outcome of acute coronary syndrome: observations from the Global Registry of Acute Coronary Events (GRACE). GRACE Publications. https://doi.org/10.1016/j.ahj.2004.06.003. Retrieved from https://escholarship.umassmed.edu/cor_grace/60