TY - JOUR
T1 - Age differences in the adherence to treatment guidelines and outcome in patients with ST-elevation myocardial infarction
AU - Gottlieb, Shmuel
AU - Behar, Solomon
AU - Schwartz, Roseline
AU - Harpaz, David
AU - Shotan, Avraham
AU - Zahger, Doron
AU - Hod, Hanoch
AU - Tzivoni, Dan
AU - Moriel, Mady
N1 - Funding Information:
We thank all the physicians and nurses who participated in ACSIS 2004 Survey, The Israel Society for the Prevention of Heart Attacks, and The Israeli Center for Disease Control, Mrs. Sherri Aharoni and Lori Mandelzweig PhD, for editorial assistance. The study was funded by the Israel Society for the Prevention of Heart Attacks , and the Working Group on Intensive Cardiac Care of the Israel Heart Society .
PY - 2011/1/1
Y1 - 2011/1/1
N2 - The aim of this study was to assess age differences in the utilization of class-I treatment guidelines and its effect on mortality in patients with ST-elevation myocardial infarction (STEMI). The study included 1026 consecutive patients from the prospective nationwide Acute Coronary Syndrome Israeli Survey (ACSIS). Primary reperfusion was used less often among elderly (age > 75 years) patients than among those aged 65-74 and <65 years (46%, 63%, 64%, respectively, p (for trend). = 0.004). Class-I evidence-based medications (EBM) at discharge (aspirin, β-blockers, angiotensin converting-enzyme inhibitors. = ACEI, angiotensin receptor-blockers. = ARBs and statins) were less frequently prescribed to elderly compared to younger age-subgroup (44%, 61%, 57%, respectively; adjusted odds ratio (OR). = 0.62; 0.40-0.97 for age ≥ 75 vs. age < 65 years). Early and 1-year mortality rates were 3-5-fold higher among the elderly compared to patients <65 years. In the entire cohort use of primary reperfusion was associated with lower 1-year mortality (OR. = 0.69; 0.47-1.01), as was the use of EBM (OR. = 0.26; 0.17-0.41). These effects were similar across all age-subgroups but with a greater impact among the elderly, as the number of patients needed to treat (NNT) was significantly lower with advancing age. Better adherence to treatment guidelines may improve the prognosis of elderly patients with STEMI.
AB - The aim of this study was to assess age differences in the utilization of class-I treatment guidelines and its effect on mortality in patients with ST-elevation myocardial infarction (STEMI). The study included 1026 consecutive patients from the prospective nationwide Acute Coronary Syndrome Israeli Survey (ACSIS). Primary reperfusion was used less often among elderly (age > 75 years) patients than among those aged 65-74 and <65 years (46%, 63%, 64%, respectively, p (for trend). = 0.004). Class-I evidence-based medications (EBM) at discharge (aspirin, β-blockers, angiotensin converting-enzyme inhibitors. = ACEI, angiotensin receptor-blockers. = ARBs and statins) were less frequently prescribed to elderly compared to younger age-subgroup (44%, 61%, 57%, respectively; adjusted odds ratio (OR). = 0.62; 0.40-0.97 for age ≥ 75 vs. age < 65 years). Early and 1-year mortality rates were 3-5-fold higher among the elderly compared to patients <65 years. In the entire cohort use of primary reperfusion was associated with lower 1-year mortality (OR. = 0.69; 0.47-1.01), as was the use of EBM (OR. = 0.26; 0.17-0.41). These effects were similar across all age-subgroups but with a greater impact among the elderly, as the number of patients needed to treat (NNT) was significantly lower with advancing age. Better adherence to treatment guidelines may improve the prognosis of elderly patients with STEMI.
KW - Aging
KW - Angioplasty
KW - Drugs
KW - Guidelines
KW - Myocardial infarction
UR - http://www.scopus.com/inward/record.url?scp=78649718801&partnerID=8YFLogxK
U2 - 10.1016/j.archger.2010.02.015
DO - 10.1016/j.archger.2010.02.015
M3 - Article
AN - SCOPUS:78649718801
SN - 0167-4943
VL - 52
SP - 118
EP - 124
JO - Archives of Gerontology and Geriatrics
JF - Archives of Gerontology and Geriatrics
IS - 1
ER -