The influence of age on health status outcomes after acute myocardial infarction.
BACKGROUND
Older age is a risk factor for higher mortality after acute myocardial infarction (AMI), but the association with health status outcomes is largely unexplored.


METHODS
In a prospective cohort of 2498 patients in the PREMIER study, we compared health-related quality of life (HRQL) and burden of angina symptoms among survivors of AMI by age strata (age groups > or = 75, 65-74, 50-64, and 19-49 years) using the Seattle Angina Questionnaire. Multivariable analyses assessed the relationship between age and 1-year HRQL and angina burden, adjusting for differences in clinical characteristics, treatment, and baseline health status.


RESULTS
Older patients comprised a majority: 20.1% were > or = 75 years of age, 41.7% were 65 to 74 years of age, 20.7% were 50 to 64 years of age, and 17.4% were < 50 years of age. At 12 months, older patients had higher mortality (17.0% vs 8.7% vs 6.1% vs 3.2% for age groups > or = 75, 65-74, 50-64, 19-49; P < .001). Among survivors of AMI, increasing age was associated with less angina and better HRQL. By 12 months, older patients reported less angina (10.9% vs 12.7% vs 19.3% vs 23.4% for age groups > or = 75, 65-74, 50-64, 19-49; P < .0001) and better HRQL (scores 89.1 vs 88.1 vs 82.5 vs 80.0, respectively; P < .0001), which persisted after adjustment for baseline angina, HRQL, and other demographic, clinical, disease severity, and treatment differences.


CONCLUSIONS
Although older patients have higher mortality after AMI, those who survive experience fewer symptoms and better HRQL at 1 year than younger patients. Angina remains present in a number of patients across the spectrum of age, supporting strategies to systematically assess and treat symptoms after AMI.
Ho
P Michael
PM
Medical Service, Denver VA Medical Center, Denver, CO, USA. michael.ho@uchsc.edu
Eng
Marvin H
MH
Rumsfeld
John S
JS
Spertus
John A
JA
Peterson
Pamela N
PN
Jones
Philip G
PG
Peterson
Eric D
ED
Alexander
Karen P
KP
Havranek
Edward P
EP
Krumholz
Harlan M
HM
Masoudi
Frederick A
FA
D000328:Adult; D000367:Age Factors; D000368:Aged; D000787:Angina Pectoris / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors