Age-related differences in the utilization of therapies post acute myocardial infarction.
OBJECTIVE
To describe the effect of age on the care of patients hospitalized with acute myocardial infarction (MI).


METHODS
Retrospective chart review of all cases with a primary or secondary discharge diagnosis of acute MI.


METHODS
Two large community hospitals in Milwaukee, Wisconsin, from July 1, 1990 to June 30, 1991.


METHODS
There were 771 charts reviewed, of which, 149 cases were aged 54 years or younger, 203 were 55 to 64 years, 224 were 65 to 74 years, and 195 were aged 75 years or older.


METHODS
Hospital charts were examined for use of diagnostic and therapeutic interventions, including medications and procedures, as well as length of stay and in-hospital mortality.


RESULTS
Older patients were more likely to be female (18%, 20%, 38%, and 56% for the four age groups, respectively, P < .001 chi-square for linear trend), more likely to present with congestive heart failure (31%, 39%, 51%, and 72%, P < .001), and had a higher in-hospital mortality rate (5%, 7%, 10%, and 18%, P < .001). Older patients had a longer length of stay in the hospital. The use of cardiac catheterization in these post-MI patients was high and did not decrease until after age 75 (85%, 88%, 88%, and 47%, P < .001). The percentage of patients receiving balloon angioplasty decreased with age (51%, 51%, 43%, and 20%, P < .001), whereas the percentage of patients receiving myocardial revascularization did not significantly differ with age (15%, 22%, 25%, and 19%, P = .46). Aspirin was less likely to be prescribed to older patients at discharge (79%, 82%, 70%, and 62%, P < .001).


CONCLUSIONS
A surprisingly high percentage of those older than age 65 received invasive tests and interventions. This high utilization rate coexists with our continued ignorance about the efficacy of these tests and interventions in older adults.
Malone
M L
ML
University of Wisconsin Medical School, Milwaukee, USA.
Sial
S H
SH
Battiola
R J
RJ
Nachodsky
J P
JP
Solomon
D J
DJ
Goodwin
J S
JS
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000800:Angioplasty, Balloon / Q000706:statistics & numerical data; D001241:Aspirin / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000628:therapy; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012737:Sex Factors; D014922:Wisconsin / Q000453:epidemiology
D002121:Calcium Channel Blockers; D001241:Aspirin