title: Age-dependent care and long-term (20 year) mortality of 14,434 myocardial infarction patients: changes from 1985 to 2008.
abstract: OBJECTIVE
  To determine whether age-dependent inequalities in care and outcome changed over a 24 year period for patients admitted with a myocardial infarction (MI).
  
  
  METHODS
  We examined four age groups (<55, 55-65, 65-75, and >75 years) and treatment and mortality in 14,434 consecutive patients admitted for MI to an intensive coronary care unit from 1985 to 2008. Temporal trend analyses were performed by comparing decades of admission (1985-1990 vs. 1990-2000 vs. 2000-2008).
  
  
  RESULTS
  A total of 2040 (14%) of the patients were >75 years of age. Older patients more often were female and less often presented with an ST-segment elevation MI (STEMI). Systematic differences in care were present between the age groups: older patients were less likely to receive evidence-based medical care and reperfusion therapy during the last 24 years, although the differences became smaller over time. In 2000-2008, 30-day (adjusted OR 0.28, 95%CI: 0.23-0.34) and 5-year (adjusted HR 0.61, 95%CI: 0.54-0.68) mortality were lower compared to 1985-1990. These temporal trends were equal across all age groups. Hence, the change in mortality over the 24-year study period is similar among the spectrum of ages. Patients aged <55, 55-65, 65-75, and >75 years had a 20-year mortality of 38, 63, 87 and >95%, respectively.
  
  
  CONCLUSIONS
  Older patients with an MI remained less likely to receive evidence-based care during 24 years of observation. Temporal reductions in mortality were similar among all age groups. The application of proven MI therapies to appropriate patients regardless of age may even further improve these outcomes.
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Ba-Ba 561 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
authors.forename: Sjoerd T
authors.initials: ST
authors.lastname: Nauta
authors.forename: Jaap W
authors.initials: JW
authors.lastname: Deckers
authors.forename: K Martijn
authors.initials: KM
authors.lastname: Akkerhuis
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
mesh_terms: D000367:Age Factors; D000368:Aged; D055317:Evidence-Based Practice; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units / Q000639:trends*; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome