Validating recommendations for coronary angiography following acute myocardial infarction in the elderly: a matched analysis using propensity scores.
We determined whether adherence to recommendations for coronary angiography more than 12 h after symptom onset but prior to hospital discharge after acute myocardial infarction (AMI) resulted in better survival. Using propensity scores, we created a matched retrospective sample of 19,568 Medicare patients hospitalized with AMI during 1994-1995 in the United States. Twenty-nine percent, 36%, and 34% of patients were judged necessary, appropriate, or uncertain, respectively, for angiography while 60% of those judged necessary received the procedure during the hospitalization. The 3-year survival benefit was largest for patients rated necessary [mean survival difference (95% CI): 17.6% (15.1, 20.1)] and smallest for those rated uncertain [8.8% (6.8, 10.7)]. Angiography recommendations appear to select patients who are likely to benefit from the procedure and the consequent interventions. Because of the magnitude of the benefit and of the number of patients involved, steps should be taken to replicate these findings.
Normand
S T
ST
Department of Health Care Policy, Harvard Medical School, Boston, MA 02115-5899, USA. sharon@hcp.med.harvard.edu
Landrum
M B
MB
Guadagnoli
E
E
Ayanian
J Z
JZ
Ryan
T J
TJ
Cleary
P D
PD
McNeil
B J
BJ
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D017023:Coronary Angiography / Q000592:standards* / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000592:standards* / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D016555:Matched-Pair Analysis; D006278:Medicare; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality; D018579:Patient Selection; D017410:Practice Guidelines as Topic / Q000592:standards*; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology