Document Detail


Changes in management of elderly patients with myocardial infarction.
MedLine Citation:
PMID:  19176538     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
François Schiele; Nicolas Meneveau; Marie France Seronde; Vincent Descotes-Genon; Joanna Oettinger; Fiona Ecarnot; Jean-Pierre Bassand;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2009-01-27
Journal Detail:
Title:  European heart journal     Volume:  30     ISSN:  1522-9645     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-04-15     Completed Date:  2009-08-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  987-94     Citation Subset:  IM    
Affiliation:
Department of Cardiology, University Hospital Jean-Minjoz, Université de Franche Comte, EA 3920 Boulevard Fleming, 25000 Besançon, France. francois.schiele@univ-fcomte.fr
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MeSH Terms
Descriptor/Qualifier:
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:
0/Cardiotonic Agents
Comments/Corrections
Comment In:
Eur Heart J. 2009 Apr;30(8):887-9   [PMID:  19318499 ]

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