Encouraging trends in acute myocardial infarction survival in the oldest old
Department of Medicine; Department of Quantitative Health Sciences
Aged, 80 and over; Analysis of Variance; Chi-Square Distribution; Female; Geriatric Assessment; Guideline Adherence; Humans; Male; Massachusetts; Myocardial Infarction; Patient Discharge; Practice Guidelines as Topic; Proportional Hazards Models; Survival Analysis
Cardiology | Cardiovascular Diseases | Clinical Epidemiology | Epidemiology | Geriatrics | Pathological Conditions, Signs and Symptoms | Pharmaceutical Preparations | Therapeutics
BACKGROUND: There are limited data informing the optimal treatment strategy for acute myocardial infarction in the oldest old (aged > /= 85 years). The study aim was to examine whether decade-long increases in guideline-based cardiac medication use mediate declines in post-discharge mortality among oldest old patients hospitalized with acute myocardial infarction.
METHODS: The study sample included 1137 patients aged > /= 85 years hospitalized in 6 biennial periods between 1997 and 2007 for acute myocardial infarction at all 11 greater Worcester, Massachusetts, medical centers. We examined trends in 90-day survival after hospital discharge and guideline-based medication use (aspirin, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers, lipid-lowering agents) for acute myocardial infarction during hospitalization and at discharge. Sequential multivariable Cox regression models examined the relationship among guideline-based medication use, study year, and 90-day post-discharge survival rates.
RESULTS: Patients hospitalized between 2003 and 2007 experienced higher 90-day survival rates than those hospitalized between 1997 and 2001 (69.1% vs 59.8%, P < .05). Between 1997 and 2007, the average number of guideline-based medications prescribed at discharge increased significantly (1.8 to 2.9, P < .001). The unadjusted hazard ratio for 90-day post-discharge mortality in 2003-2007 compared with 1997-2001 was 0.73 (95% confidence interval, 0.60-0.89); after adjustment for patient characteristics and guideline-based cardiac medication use, this relationship was no longer significant (hazard ratio, 1.26; 95% confidence interval, 1.00-1.58).
CONCLUSIONS: Between 1997 and 2007, 90-day survival improved among a population-based sample of patients aged > /= 85 years hospitalized for acute myocardial infarction. This encouraging trend was explained by increased use of guideline-based medications.
Acute myocardial infarction, Geriatrics, Medication effects, Post-discharge survival
DOI of Published Version
Am J Med. 2013 Sep;126(9):798-804. doi: 10.1016/j.amjmed.2013.02.026. Link to article on publisher's site
The American journal of medicine
Tjia J, Allison JJ, Saczynski JS, Tisminetzky M, Givens JL, Lapane KL, Lessard DM, Goldberg RJ. (2013). Encouraging trends in acute myocardial infarction survival in the oldest old. University of Massachusetts Medical School Faculty Publications. https://doi.org/10.1016/j.amjmed.2013.02.026. Retrieved from https://escholarship.umassmed.edu/faculty_pubs/464