Age-specific differences in the use of thrombolytic therapy and hospital outcomes in patients with acute myocardial infarction: a community-wide perspective.
BACKGROUND
Relatively limited information is available about recent, and trends over time, use of thrombolytic therapy in patients of different ages hospitalized with acute myocardial infarction and the association between use of thrombolytic therapy and hospital outcomes.


METHODS
We conducted an observational study of 5601 residents of the Worcester, Massachusetts, metropolitan area (1990 census = 437,000) with confirmed acute myocardial infarction in all local hospitals during 6 one-year periods between 1990 and 1999.


RESULTS
Despite relatively stable use of thrombolytic therapy between 1990 and 1995, decreases in the use of thrombolytic therapy in all patients with acute myocardial infarction were observed in 1997 and 1999. There was a 1.6 fold decrease in the use of thrombolytic therapy between 1990 and 1999 in patients <65 years. Patients 65-74 years (33.7% 1990; 11.7% 1999) and those 75 years and older (10.8% 1990; 6.7% 1999) experienced marked decreases in the receipt of thrombolytic therapy over time. Use of thrombolytic therapy was associated with reduced hospital mortality in each of the four age-specific groups under study (<55, 55-64, 65-74, > or =75) through the degree of benefit on hospital death rates associated with the use of thrombolytic therapy was attenuated after adjustment for additional confounders.


CONCLUSIONS
Our findings indicate recent declines in the use of thrombolytic therapy in middle-aged and elderly patients with acute myocardial infarction. The impact of thrombolytic therapy on hospital outcomes was observed in each of our age strata under study though the magnitude of absolute and relative benefit varied according to age.
Ali
Omar
O
Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
Sadiq
Immad
I
Goldberg
Robert J
RJ
Yarzebski
Jorge
J
Lessard
Darleen
D
Gurwitz
Jerry
J
Gore
Joel M
JM
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000187:drug effects; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D012044:Regression Analysis; D012111:Residence Characteristics / Q000706:statistics & numerical data; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data / Q000639:trends; D016896:Treatment Outcome