Effects of age on the quality of care provided to older patients with acute myocardial infarction.
OBJECTIVE
Older patients are less likely to receive guideline-recommended medical therapies during acute myocardial infarction. However, it is unclear whether the lower rates of treatment reflect elderly patients' increased number of comorbid conditions, physician or hospital effects, or true age-associated variation. Furthermore, it is unclear whether age-associated variations in care are similar or vary among treatments.


METHODS
We evaluated 146,718 Medicare patients from the Cooperative Cardiovascular Project aged > or =65 years who were hospitalized between 1994 and 1996 with a confirmed myocardial infarction, to ascertain whether rates of acute reperfusion therapy and use of aspirin (admission, discharge), beta-blockers (admission, discharge), and angiotensin-converting enzyme (ACE) inhibitors varied among patients aged 65 to 69 years, 70 to 74 years, 75 to 79 years, 80 to 84 years, and > or =85 years. We identified patients who were considered eligible for each therapy and who had no treatment contraindications. Associations between age and use of therapy were assessed, adjusting for patient, physician, hospital, and geographic factors.


RESULTS
Adjusted treatment rates were higher for patients aged 65 to 69 years than for patients aged > or =85 years for acute reperfusion therapy (54.4% vs. 31.2%, P <0.0001 for trend), beta-blockers (admission: 52.2% vs. 43.8%, P <0.0001 for trend; discharge: 61.8% vs. 55.3%, P <0.0001 for trend), aspirin at admission (73.8% vs. 71.0%, P <0.0001 for trend), and ACE inhibitors (61.6% vs. 57.1%, P = 0.02 for trend); there were no differences in the prescription of aspirin at discharge (76.0% vs. 73.6%, P = 0.05).


CONCLUSIONS
Elderly patients are less likely to receive guideline-indicated therapies when hospitalized with myocardial infarction. The effects of age were largest for acute reperfusion and smallest for aspirin.
Rathore
Saif S
SS
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
Mehta
Rajendra H
RH
Wang
Yongfei
Y
Radford
Martha J
MJ
Krumholz
Harlan M
HM
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000379:methods; D003325:Coronary Care Units / Q000592:standards*; D003422:Critical Care / Q000592:standards* / Q000639:trends; D004363:Drug Utilization; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006299:Health Services for the Aged / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000592:standards; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011787:Quality of Health Care; D018570:Risk Assessment; D016019:Survival Analysis; D015912:Thrombolytic Therapy / Q000379:methods*; D014481:United States
D000319:Adrenergic beta-Antagonists