title: Factors affecting cardiac catheterization rates in elders with acute coronary syndromes.
abstract: BACKGROUND
  Elder patients with acute coronary syndromes (ACS) are less likely to receive cardiac catheterization. The reasons for this are unclear.
  
  
  OBJECTIVE
  To assess whether elder patients who had a documented history of dementia, lived in extended care facilities, or had do not intubate-do not resuscitate (DNR-DNI) advance directives were less likely to receive cardiac catheterization, despite having ACS with high-risk features.
  
  
  METHODS
  This was a medical record review conducted at an urban teaching hospital. DNR-DNI status before hospitalization, extended care facility (nursing home or assisted living) residence, and a previous diagnosis of dementia were obtained from the medical record. Patients 65 years and older who presented to the emergency department with acute myocardial infarction or with unstable angina with ST segment deviation were included. Univariate and multivariate logistic regression were performed, and odds ratios (ORs) were reported with their 95% confidence intervals (CIs).
  
  
  RESULTS
  Of the 201 eligible patients, 66 (32.8%) patients did not undergo cardiac catheterization. In the univariate analysis, patients who had dementia, resided in extended care facilities, or were DNR-DNI were less likely to receive cardiac catheterization. Only extended care facility residence (OR, 0.18; 95% CI = 0.04 to 0.83) and DNR-DNI status (OR, 0.19; 95% CI = 0.04 to 0.92) remained significantly associated with decreased cardiac catheterization in the multivariate analysis.
  
  
  CONCLUSIONS
  Elder patients with ACS residing in extended care facilities or who are DNR-DNI are less likely to receive cardiac catheterization. Future studies concerning the quality of ACS care for elders should take these variables into account.
authors.affiliation: Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. jin.h.han@vanderbilt.edu
authors.forename: Jin H
authors.initials: JH
authors.lastname: Han
authors.forename: Karen F
authors.initials: KF
authors.lastname: Miller
authors.forename: Alan B
authors.initials: AB
authors.lastname: Storrow
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000706:statistics & numerical data*; D002637:Chest Pain / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D003704:Dementia / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D009735:Nursing Homes / Q000706:statistics & numerical data; D016017:Odds Ratio; D016414:Resuscitation Orders; D012189:Retrospective Studies; D013610:Tachycardia / Q000175:diagnosis / Q000453:epidemiology; D013714:Tennessee / Q000453:epidemiology