title: Management and outcomes of ST-elevation myocardial infarction in nursing home versus community-dwelling older patients: a propensity matched study.
abstract: OBJECTIVE
  The influence of admission source (nursing home [NH] versus community-dwelling) on treatment strategies and outcomes among elderly patients with ST-elevation myocardial infarction (STEMI) has not been investigated.
  
  
  METHODS
  Nationwide Inpatient Sample databases from 2003 to 2010 were used to identify 270,117 community-dwelling and 4082 NH patients 75 years of age or older with STEMI.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Propensity scores for admission source were used to assemble a matched cohort of 3081 community-dwelling and 3132 NH patients, who were balanced on baseline demographic and clinical characteristics. Bivariate logistic regression models were then used to determine the associations of NH with in-hospital outcomes among matched patients.
  
  
  RESULTS
  In-hospital mortality was significantly higher in patients with STEMI presenting from a NH as compared with community-dwelling patients (30.5% versus 27.6%; odds ratio [OR] 1.15, 95% confidence interval [CI] 1.03-1.29; P = .012). Overall, NH patients were less likely to receive reperfusion (thrombolysis, percutaneous coronary intervention, or coronary artery bypass grafting) (11.5% versus 13.4%; OR 0.84, 95% CI 0.72-0.98; P = .022). However, rates of percutaneous coronary intervention alone were similar in both groups (9.9% in NH versus 9.1% in community-dwelling; OR 1.10, 95% CI 0.93-1.30; P = .276). Mean length of stay was also similar in both groups (5.68 ± 5.40 days in NH versus 5.69 ± 4.98 days in community-dwelling, P = .974).
  
  
  CONCLUSIONS
  Compared with their community-dwelling counterparts, older NH patients are less likely to receive reperfusion therapy for STEMI and have higher in-hospital mortality.
authors.affiliation: New York Medical College, Valhalla, NY.
authors.forename: Sahil
authors.initials: S
authors.lastname: Khera
authors.affiliation: New York Medical College, Valhalla, NY.
authors.forename: Dhaval
authors.initials: D
authors.lastname: Kolte
authors.affiliation: New York Medical College, Valhalla, NY.
authors.forename: Tanush
authors.initials: T
authors.lastname: Gupta
authors.affiliation: New York Medical College, Valhalla, NY.
authors.forename: Marjan
authors.initials: M
authors.lastname: Mujib
authors.affiliation: New York Medical College, Valhalla, NY. Electronic address: wsaronow@aol.com.
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.affiliation: New York Medical College, Valhalla, NY.
authors.forename: Pallak
authors.initials: P
authors.lastname: Agarwal
authors.affiliation: New York Medical College, Valhalla, NY.
authors.forename: Chandrasekar
authors.initials: C
authors.lastname: Palaniswamy
authors.affiliation: New York Medical College, Valhalla, NY.
authors.forename: Diwakar
authors.initials: D
authors.lastname: Jain
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmed
authors.affiliation: David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: New York Medical College, Valhalla, NY.
authors.forename: William H
authors.initials: WH
authors.lastname: Frishman
authors.affiliation: New York Medical College, Valhalla, NY.
authors.forename: Julio A
authors.initials: JA
authors.lastname: Panza
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D009735:Nursing Homes; D010343:Patient Admission / Q000706:statistics & numerical data*; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: ST-elevation myocardial infarction; admission source; in-hospital mortality; nursing home