Age-related differences in the use of guideline-recommended medical and interventional therapies for acute coronary syndromes: a cohort study.
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.
Schoenenberger
Andreas W
AW
Department of Geriatrics, Inselspital University of Bern Hospital, Bern, Switzerland.
Radovanovic
Dragana
D
Stauffer
Jean-Christophe
JC
Windecker
Stephan
S
Urban
Philip
P
Eberli
Franz R
FR
Stuck
Andreas E
AE
Gutzwiller
Felix
F
Erne
Paul
P
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
D000319:Adrenergic beta-Antagonists; D006401:Hematologic Agents