Trends in Management, Hospital and Long-Term Outcomes of Elderly Patients with Acute Myocardial Infarction

Shmuel Gottlieb, Solomon Behar, Hanoch Hod, Doron Zahger, Jonathan Leor, David Hasdai, Haim Hammerman, Silviu Wagner, Amir Sandach, Roseline Schwartz, Manfred S. Green, Abraham Adunsky

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

Purpose: The number of elderly patients with acute myocardial infarction (AMI) is growing rapidly, and their early and postdischarge mortality is high. Several studies have reported a decline in mortality after myocardial infarction; however, the magnitude of the decline among the elderly has not been fully investigated. Methods: We assessed trends in management, in-hospital, and long-term outcomes of 1475 elderly patients (aged ≥75 years, 42% women) hospitalized with AMI in all 25 operating coronary care units in Israel between 1992 and 2002, from our prospective nationwide biennial surveys. Results: Between 1992 and 2002, a significant increase was observed in the use of acute reperfusion therapy (27%-48%), coronary angiography (6%-47%), percutaneous coronary intervention (3%-33%), coronary bypass (2%-8%), aspirin (53%-88%), beta-blockers (18%-65%), angiotensin-converting enzyme inhibitors (26%-63%), and lipid-lowering drugs (0%-43%). These changes were associated with a 42% reduction in 30-day mortality (27.6%-16.1%; adjusted odds ratio 0.57; 95% confidence interval [CI], 0.36-0.93). One-year cumulative mortality declined by 20% (37%-29%; adjusted odds ratio 0.74; 95% CI, 0.49-1.13). Conclusions: The management of elderly patients with AMI changed substantially during the last decade. This change was associated with a significant reduction in early mortality, whereas cumulative 1-year mortality improved only slightly. Better adherence to in-hospital management guidelines and better implementation of postdischarge health policy may further decrease mortality and morbidity in the elderly after AMI.

Original languageEnglish
Pages (from-to)90-97
Number of pages8
JournalAmerican Journal of Medicine
Volume120
Issue number1
DOIs
StatePublished - 1 Jan 2007
Externally publishedYes

Keywords

  • Elderly
  • Management
  • Myocardial infarction
  • Outcome
  • Reperfusion

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