Older emergency department patients with acute myocardial infarction receive lower quality of care than younger patients.
OBJECTIVE
We assessed the independent relationship between age and the quality of medical care provided to patients presenting to the emergency department (ED) with acute myocardial infarction.


METHODS
We conducted a 2-year retrospective cohort study of 2,216 acute myocardial infarction patients presenting urgently to 5 EDs in Colorado and California from July 1, 2000, through June 30, 2002. Data on patient characteristics, clinical presentation, and ED processes of care were obtained from the ED record and ECG review. Patients were divided into 6 groups based on their age at the time of their ED visit: younger than 50 years, 50 to 59 years, 60 to 69 years, 70 to 79 years, 80 to 89 years, and 90 years or older. Hierarchic multivariable regression was used to assess the independent association between age and the provision of aspirin, beta-blockers, and reperfusion therapy (fibrinolytic agent or percutaneous coronary intervention) in the ED to eligible acute myocardial infarction patients.


RESULTS
Of ideal candidates for treatment in the ED, 1,639 (80.5%) of 2,036 received aspirin, 552 (60.3%) of 916 received beta-blockers, and 358 (77.8%) of 460 received acute reperfusion therapy. After adjustment for demographic, medical history, and clinical factors, older patients were less likely to receive aspirin (odds ratio [OR] 0.85, 95% confidence interval [CI] 0.77 to 0.93), beta-blockers (OR 0.79, 95% CI 0.71 to 0.88), and reperfusion therapy (OR 0.30, 95% CI 0.18 to 0.52).


CONCLUSIONS
Older patients presenting to the ED with acute myocardial infarction receive lower-quality medical care than younger patients. Further investigation to identify the reasons for this disparity and to intervene to reduce gaps in care quality will likely lead to improved outcomes for older acute myocardial infarction patients.
Kaiser Permanente Clinical Research Unit, Denver, CO 90237-8066, USA. David.J.Magid@kp.org
David J
DJ
Magid
Frederick A
FA
Masoudi
David R
DR
Vinson
Theresa M
TM
van der Vlugt
Thomas G
TG
Padgett
Albert J
AJ
Tricomi
Ella E
EE
Lyons
Laurie
L
Crounse
David W
DW
Brand
Alan S
AS
Go
P Michael
PM
Ho
John S
JS
Rumsfeld
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000627:therapeutic use; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D003120:Colorado / Q000453:epidemiology; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017678:Sex Distribution
D000319:Adrenergic beta-Antagonists; D005343:Fibrinolytic Agents; D001241:Aspirin