title: Relationship between care gaps and projected life expectancy after acute myocardial infarction.
abstract: BACKGROUND
  Higher-risk patients may not receive evidence-based therapy because of limited life expectancy, which is a composite measure that encompasses many patient factors, including age, frailty, and comorbidities. In this study, we evaluated the extent to which treatment care gaps can be explained by a difference in projected life expectancy.
  
  
  RESULTS
  An observational cohort study was conducted on acute myocardial infarction patients hospitalized in Ontario, Canada. Projected life expectancy was estimated using actual survival data with extrapolation using proportional hazard models adjusting for important covariates. The relationship between projected life expectancy with statins and reperfusion therapy was examined using generalized linear models. Among the 7001 acute myocardial infarction patients, 84.3% were prescribed statins and 72.9% were treated with reperfusion therapy. When projected life expectancy was <10 years, the likelihood of receiving either treatment declined progressively with reduction in life expectancy (P<0.001). At the 25th percentile of projected life expectancies, the likelihood of receiving a statin decreased by 1.4% (95% confidence interval, 1.0-1.8%), and acute reperfusion therapy decreased by 2.6% (95% confidence interval, 1.8-3.3%) for each year decline in projected life expectancy.
  
  
  CONCLUSIONS
  Life expectancy of a patient strongly influences evidence-based treatment in acute myocardial infarction. It was seen not only among patients with limited life expectancies but also among those with many years to live. Treatment care gaps may reflect clinicians' synthesis about frailty and life-expectancy gains.
authors.affiliation: From the Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.T.K., P.C.A., J.V.T., D.S.L., L.Y., D.A.A.); Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (D.T.K., J.V.T.); University of Toronto, Toronto, Ontario, Canada (D.T.K., P.C.A., J.V.T., D.S.L., D.A.A.); Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada (D.S.L.); The Cardiac and Secondary Prevention Program, Toronto Rehabilitation Institute, Toronto, Ontario, Canada (D.A.A.); and Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada (D.A.A.). dennis.ko@ices.on.ca.
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Ko
authors.affiliation: From the Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.T.K., P.C.A., J.V.T., D.S.L., L.Y., D.A.A.); Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (D.T.K., J.V.T.); University of Toronto, Toronto, Ontario, Canada (D.T.K., P.C.A., J.V.T., D.S.L., D.A.A.); Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada (D.S.L.); The Cardiac and Secondary Prevention Program, Toronto Rehabilitation Institute, Toronto, Ontario, Canada (D.A.A.); and Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada (D.A.A.).
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
authors.affiliation: From the Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.T.K., P.C.A., J.V.T., D.S.L., L.Y., D.A.A.); Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (D.T.K., J.V.T.); University of Toronto, Toronto, Ontario, Canada (D.T.K., P.C.A., J.V.T., D.S.L., D.A.A.); Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada (D.S.L.); The Cardiac and Secondary Prevention Program, Toronto Rehabilitation Institute, Toronto, Ontario, Canada (D.A.A.); and Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada (D.A.A.).
authors.forename: Jack V
authors.initials: JV
authors.lastname: Tu
authors.affiliation: From the Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.T.K., P.C.A., J.V.T., D.S.L., L.Y., D.A.A.); Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (D.T.K., J.V.T.); University of Toronto, Toronto, Ontario, Canada (D.T.K., P.C.A., J.V.T., D.S.L., D.A.A.); Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada (D.S.L.); The Cardiac and Secondary Prevention Program, Toronto Rehabilitation Institute, Toronto, Ontario, Canada (D.A.A.); and Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada (D.A.A.).
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Lee
authors.affiliation: From the Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.T.K., P.C.A., J.V.T., D.S.L., L.Y., D.A.A.); Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (D.T.K., J.V.T.); University of Toronto, Toronto, Ontario, Canada (D.T.K., P.C.A., J.V.T., D.S.L., D.A.A.); Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada (D.S.L.); The Cardiac and Secondary Prevention Program, Toronto Rehabilitation Institute, Toronto, Ontario, Canada (D.A.A.); and Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada (D.A.A.).
authors.forename: Lingsong
authors.initials: L
authors.lastname: Yun
authors.affiliation: From the Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.T.K., P.C.A., J.V.T., D.S.L., L.Y., D.A.A.); Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (D.T.K., J.V.T.); University of Toronto, Toronto, Ontario, Canada (D.T.K., P.C.A., J.V.T., D.S.L., D.A.A.); Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada (D.S.L.); The Cardiac and Secondary Prevention Program, Toronto Rehabilitation Institute, Toronto, Ontario, Canada (D.A.A.); and Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada (D.A.A.).
authors.forename: David A
authors.initials: DA
authors.lastname: Alter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D003695:Delivery of Health Care; D005500:Follow-Up Studies; D008017:Life Expectancy; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy; D009204:Myocardial Revascularization / Q000379:methods; D009864:Ontario / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: health services research; life expectancy; myocardial infarction