| Changes in management of elderly patients with myocardial infarction. | |
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MedLine Citation:
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PMID: 19176538 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIMS: Despite being at higher risk for mortality, elderly patients (>/=75 years) admitted for acute myocardial infarction (MI) often receive fewer effective therapies, because of contraindications or higher risk of drug-induced adverse events. The aim of this study was to assess the changes in the use of effective treatments between 2001 and 2006 in elderly patients, and the relation with 1-month mortality. METHODS AND RESULTS: Prospective, multicentre registry, considering two periods: 6 months between October 2000 and March 2001 (cohort 1) and 12 months between October 2005 and October 2006 (cohort 2). Demographic and clinical characteristics at admission, in-hospital treatment (reperfusion or early invasive therapy, oral antiplatelets, anticoagulants, angiotensin-converting enzyme (ACE)-inhibitors, beta-blockers, and statins), and 1-month survival were compared between the two cohorts, after adjustment on a propensity score (for being admitted in 2001). Eight hundred and sixty-eight elderly patients were included, 280 in cohort 1 and 588 in cohort 2. When compared with cohort 1, patients from cohort 2 presented with comparable characteristics, except for the Global Registry of Acute Coronary Events risk score and we observed a significant increase in the use of aspirin, clopidogrel, reperfusion therapy, ACE-inhibitors, and statins in cohort 2. One-month mortality was significantly lower in cohort 2 (13.6% in cohort 1 vs. 7.1% in cohort 2, P = 0.001), mainly driven by a decrease in the mortality among patients with ST-segment elevation MI (23.3% in cohort 1 vs. 9.2% in cohort 2, P < 0.001). Adjustment on the propensity score did not alter these results. By multivariable analysis, the three-fold higher mortality in patients from cohort 1 was offset when the rate of use of treatments was considered in the model, suggesting that the treatment intensity was related to lower mortality. CONCLUSION: Between 2001 and 2006, a significant increase in the use of guidelines-recommended treatments (GRTs) was observed, associated with lower 30-day mortality, in elderly patients. These data confirm that high-risk patients, such as the elderly, benefit from an increase in the use of GRTs. |
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Authors:
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François Schiele; Nicolas Meneveau; Marie France Seronde; Vincent Descotes-Genon; Joanna Oettinger; Fiona Ecarnot; Jean-Pierre Bassand; |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't Date: 2009-01-27 |
Journal Detail:
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Title: European heart journal Volume: 30 ISSN: 1522-9645 ISO Abbreviation: Eur. Heart J. Publication Date: 2009 Apr |
Date Detail:
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Created Date: 2009-04-15 Completed Date: 2009-08-20 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8006263 Medline TA: Eur Heart J Country: England |
Other Details:
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Languages: eng Pagination: 987-94 Citation Subset: IM |
Affiliation:
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Department of Cardiology, University Hospital Jean-Minjoz, Université de Franche Comte, EA 3920 Boulevard Fleming, 25000 Besançon, France. francois.schiele@univ-fcomte.fr |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged, 80 and over Cardiotonic Agents / therapeutic use* Epidemiologic Methods Female France / epidemiology Health Services for the Aged / trends Humans Male Myocardial Infarction / drug therapy*, mortality Myocardial Reperfusion / mortality Practice Guidelines as Topic |
| Chemical | |
Reg. No./Substance:
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0/Cardiotonic Agents |
| Comments/Corrections | |
Comment In:
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Eur Heart J. 2009 Apr;30(8):887-9
[PMID:
19318499
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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