title: Age-related differences in the use of guideline-recommended medical and interventional therapies for acute coronary syndromes: a cohort study.
abstract: OBJECTIVE
  To compare the use of guideline-recommended medical and interventional therapies in older and younger patients with acute coronary syndromes (ACSs).
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Fifty-five hospitals in Switzerland.
  
  
  METHODS
  Eleven thousand nine hundred thirty-two patients with ACS enrolled between March 1, 2001, and June 30, 2006. ACS definition included ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina pectoris (UA).
  
  
  METHODS
  Use of medical and interventional therapies was determined after exclusion of patients with contraindications and after adjustment for comorbidities. Multivariate logistic regression models were used to calculate odds ratios (ORs) per year increase in age.
  
  
  RESULTS
  Elderly patients were less likely to receive acetylsalicylic acid (OR=0.976, 95% confidence interval (CI)=0.969-0.980) or beta-blockers (OR=0.985, 95% CI=0.981-0.989). No age-dependent difference was found for heparin use. Elderly patients with STEMI were less likely to receive percutaneous coronary intervention (PCI) or thrombolysis (OR=0.955, 95% CI=0.949-0.961). Elderly patients with NSTEMI or UA less often underwent PCI (OR=0.943, 95% CI=0.937-0.949).
  
  
  CONCLUSIONS
  Elderly patients across the whole spectrum of ACS were less likely to receive guideline-recommended therapies, even after adequate adjustment for comorbidities. Prognosis of elderly patients with ACS may be improved by increasing adherence to guideline-recommended medical and interventional therapies.
authors.affiliation: Department of Geriatrics, Inselspital University of Bern Hospital, Bern, Switzerland.
authors.forename: Andreas W
authors.initials: AW
authors.lastname: Schoenenberger
authors.forename: Dragana
authors.initials: D
authors.lastname: Radovanovic
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Stauffer
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.forename: Philip
authors.initials: P
authors.lastname: Urban
authors.forename: Franz R
authors.initials: FR
authors.lastname: Eberli
authors.forename: Andreas E
authors.initials: AE
authors.lastname: Stuck
authors.forename: Felix
authors.initials: F
authors.lastname: Gutzwiller
authors.forename: Paul
authors.initials: P
authors.lastname: Erne
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D019983:Guideline Adherence; D006401:Hematologic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D017410:Practice Guidelines as Topic; D013557:Switzerland; D015912:Thrombolytic Therapy
chemical_list: D000319:Adrenergic beta-Antagonists; D006401:Hematologic Agents