title: The effect of comorbidity on use of thrombolysis or aspirin in patients with acute myocardial infarction eligible for treatment.
abstract: OBJECTIVE
  Growing evidence indicates that life-sustaining therapies for the treatment of acute myocardial infarction (AMI) are underused among patients eligible for therapy, including the elderly and women. We examined the effect of a patient's comorbidity burden on use of these highly effective therapies in eligible populations of individuals with AMI.
  
  
  METHODS
  Retrospective cohort design.
  
  
  METHODS
  We reviewed the medical records of 2,409 individuals at 37 Minnesota hospitals from October 1992 through July 1993 with an admission diagnosis of AMI, suspected AMI, or rule-out AMI, who met electrocardiographic, laboratory, and clinical criteria for AMI.
  
  
  RESULTS
  Using multivariate logistic regression models, we determined the association between a validated comorbidity measure and the proportion of eligible patients who received thrombolysis or aspirin. Controlling for other factors previously reported to influence rates of study treatment, the odds of receipt of thrombolysis among patients with severe comorbidity was 0.49 (95% confidence interval [CI] 0.27, 0.88) when compared with individuals without such limitation. Similarly, the odds of aspirin treatment among study patients with severe comorbidity was 0.46 (95% CI 0.30 0.72), compared with individuals without severe comorbidity. We did not distinguish any differences in patterns of treatment with either study treatment among patients with mild or moderate comorbidity when compared with individuals without any concomitant comorbidity.
  
  
  CONCLUSIONS
  This study indicates that patients with severe mental and physical comorbidities are less likely to receive standard therapies for AMI recommended in national treatment guidelines.
authors.affiliation: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA 02215, USA.
authors.forename: T J
authors.initials: TJ
authors.lastname: McLaughlin
authors.forename: S B
authors.initials: SB
authors.lastname: Soumerai
authors.forename: D J
authors.initials: DJ
authors.lastname: Willison
authors.forename: J H
authors.initials: JH
authors.lastname: Gurwitz
authors.forename: X
authors.initials: X
authors.lastname: Gao
authors.forename: C
authors.initials: C
authors.lastname: Borbas
authors.forename: F
authors.initials: F
authors.lastname: Gobel
mesh_terms: D000368:Aged; D001241:Aspirin / Q000627:therapeutic use*; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D003657:Decision Making; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D016017:Odds Ratio; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D015912:Thrombolytic Therapy
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin