title: Quality of acute myocardial infarction care and outcomes in 33,997 patients aged 80 years or older: findings from Get With The Guidelines-Coronary Artery Disease (GWTG-CAD).
abstract: OBJECTIVE
  To determine the adherence to national guidelines and in-hospital mortality of older patients with acute myocardial infarction (AMI) using a national database.
  
  
  BACKGROUND
  Prior studies have demonstrated that older patients are less likely to receive evidence-based therapies.
  
  
  METHODS
  Using data from the GWTG-CAD, we examined care and in-hospital outcomes among AMI patients treated at 416 US centers from 2000 to 2009. Evidence-based medical therapy, other quality measures, and in-hospital post-AMI mortality were analyzed.
  
  
  RESULTS
  A total of 156,677 patients were included in the study; 21.7% (n = 33,997) were aged ≥80 years, 33.0% (n = 51,773) 65 to 79 years, and 45.3% (n = 70,907) 18 to 64 years. Older patients had higher prevalence of comorbidities compared to younger patients. Overall, compliance with evidence-based medical treatment upon admission and discharge was high, but age-related differences in care were seen for most measures. After multivariate adjustment, the mortality of the patients aged ≥80 years was substantially higher compared to the youngest cohort (adjusted OR 3.4, 95% CI 3.2-3.8, P < .0001). There were substantial improvements in AMI quality measures over time in each age group.
  
  
  CONCLUSIONS
  Among AMI patients aged ≥80 years, the use of evidence-based therapies was high and significant improvements over time have been observed in a national quality improvement program. Nevertheless, there remain important age-related gaps in care and outcomes, suggesting opportunities exist to improve prognosis in this high-risk population.
authors.affiliation: Cardiac MR, PET, CT Program, Department of Radiology, Division of Cardiology, Massachusetts General Hospital, Boston, USA.
authors.forename: Hector M
authors.initials: HM
authors.lastname: Medina
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.forename: Xin
authors.initials: X
authors.lastname: Zhao
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Li
authors.initials: L
authors.lastname: Liang
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy*; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011787:Quality of Health Care / Q000592:standards*; D014481:United States / Q000453:epidemiology; D055815:Young Adult