title: Trends in management, hospital and long-term outcomes of elderly patients with acute myocardial infarction.
abstract: OBJECTIVE
  The number of elderly patients with acute myocardial infarction (AMI) is growing rapidly, and their early and postdischarge mortality is high. Several studies have reported a decline in mortality after myocardial infarction; however, the magnitude of the decline among the elderly has not been fully investigated.
  
  
  METHODS
  We assessed trends in management, in-hospital, and long-term outcomes of 1475 elderly patients (aged > or =75 years, 42% women) hospitalized with AMI in all 25 operating coronary care units in Israel between 1992 and 2002, from our prospective nationwide biennial surveys.
  
  
  RESULTS
  Between 1992 and 2002, a significant increase was observed in the use of acute reperfusion therapy (27%-48%), coronary angiography (6%-47%), percutaneous coronary intervention (3%-33%), coronary bypass (2%-8%), aspirin (53%-88%), beta-blockers (18%-65%), angiotensin-converting enzyme inhibitors (26%-63%), and lipid-lowering drugs (0%-43%). These changes were associated with a 42% reduction in 30-day mortality (27.6%-16.1%; adjusted odds ratio 0.57; 95% confidence interval [CI], 0.36-0.93). One-year cumulative mortality declined by 20% (37%-29%; adjusted odds ratio 0.74; 95% CI, 0.49-1.13).
  
  
  CONCLUSIONS
  The management of elderly patients with AMI changed substantially during the last decade. This change was associated with a significant reduction in early mortality, whereas cumulative 1-year mortality improved only slightly. Better adherence to in-hospital management guidelines and better implementation of postdischarge health policy may further decrease mortality and morbidity in the elderly after AMI.
authors.affiliation: Cardiology Department, Bikur Cholim Hospital, Jerusalem.-Hashomer. sgott@md.huji.ac.il
authors.forename: Shmuel
authors.initials: S
authors.lastname: Gottlieb
authors.forename: Solomon
authors.initials: S
authors.lastname: Behar
authors.forename: Hanoch
authors.initials: H
authors.lastname: Hod
authors.forename: Doron
authors.initials: D
authors.lastname: Zahger
authors.forename: Jonathan
authors.initials: J
authors.lastname: Leor
authors.forename: David
authors.initials: D
authors.lastname: Hasdai
authors.forename: Haim
authors.initials: H
authors.lastname: Hammerman
authors.forename: Silviu
authors.initials: S
authors.lastname: Wagner
authors.forename: Amir
authors.initials: A
authors.lastname: Sandach
authors.forename: Roseline
authors.initials: R
authors.lastname: Schwartz
authors.forename: Manfred S
authors.initials: MS
authors.lastname: Green
authors.forename: Abraham
authors.initials: A
authors.lastname: Adunsky
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007557:Israel / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D012042:Registries; D015996:Survival Rate