title: Encouraging trends in acute myocardial infarction survival in the oldest old.
abstract: BACKGROUND
  There are limited data informing the optimal treatment strategy for acute myocardial infarction in the oldest old (aged ≥85 years). The study aim was to examine whether decade-long increases in guideline-based cardiac medication use mediate declines in post-discharge mortality among oldest old patients hospitalized with acute myocardial infarction.
  
  
  METHODS
  The study sample included 1137 patients aged ≥85 years hospitalized in 6 biennial periods between 1997 and 2007 for acute myocardial infarction at all 11 greater Worcester, Massachusetts, medical centers. We examined trends in 90-day survival after hospital discharge and guideline-based medication use (aspirin, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers, lipid-lowering agents) for acute myocardial infarction during hospitalization and at discharge. Sequential multivariable Cox regression models examined the relationship among guideline-based medication use, study year, and 90-day post-discharge survival rates.
  
  
  RESULTS
  Patients hospitalized between 2003 and 2007 experienced higher 90-day survival rates than those hospitalized between 1997 and 2001 (69.1% vs 59.8%, P < .05). Between 1997 and 2007, the average number of guideline-based medications prescribed at discharge increased significantly (1.8 to 2.9, P < .001). The unadjusted hazard ratio for 90-day post-discharge mortality in 2003-2007 compared with 1997-2001 was 0.73 (95% confidence interval, 0.60-0.89); after adjustment for patient characteristics and guideline-based cardiac medication use, this relationship was no longer significant (hazard ratio, 1.26; 95% confidence interval, 1.00-1.58).
  
  
  CONCLUSIONS
  Between 1997 and 2007, 90-day survival improved among a population-based sample of patients aged ≥85 years hospitalized for acute myocardial infarction. This encouraging trend was explained by increased use of guideline-based medications.
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA. jennifer.tjia@umassmed.edu
authors.forename: Jennifer
authors.initials: J
authors.lastname: Tjia
authors.forename: Jeroan
authors.initials: J
authors.lastname: Allison
authors.forename: Jane S
authors.initials: JS
authors.lastname: Saczynski
authors.forename: Mayra
authors.initials: M
authors.lastname: Tisminetzky
authors.forename: Jane L
authors.initials: JL
authors.lastname: Givens
authors.forename: Kate
authors.initials: K
authors.lastname: Lapane
authors.forename: Darleen
authors.initials: D
authors.lastname: Lessard
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
mesh_terms: D000369:Aged, 80 and over; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D005260:Female; D015577:Geriatric Assessment; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality*; D010351:Patient Discharge; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D016019:Survival Analysis
keywords: Acute myocardial infarction; Geriatrics; Medication effects; Post-discharge survival