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Effect of age on the use of evidence-based therapies for acute myocardial infarction.
Am Heart J. 2004 Nov; 148(5):834-41.AH

Abstract

BACKGROUND

Previous studies have documented an underuse of evidence-based therapies in patients with acute myocardial infarction (AMI). However, many of these studies failed to consider contraindications to therapy, the effect of age (ie, elderly vs non-elderly patients) on use, or both. The objective of this study was to determine whether elderly patients are less likely than non-elderly patients to receive evidence-based AMI treatments, both before and after the consideration of contraindications to therapy.

METHODS

A retrospective chart review of a random sample of 5131 patients with AMI who were admitted to 1 of 44 hospitals in Ontario was conducted for the fiscal years 1994 to 1996. Using the Canadian Cardiovascular Research Team (CCORT)/Canadian Cardiovascular Society (CCS) Quality Indicators for AMI Care, we classified patients as being eligible or ideal (ie, no contraindications to treatment) candidates to receive aspirin, beta-blockers, thrombolysis, angiotensin-converting enzyme inhibitors (ACEIs), or statins or to undergo lipid profiling. The proportions of eligible and ideal patients who received treatment were calculated, and the latter were compared with benchmarks.

RESULTS

The median age of the cohort was 69 years; 63% were of the patients were aged > or =65 years. There was underperformance of prescribing treatments in ideal candidates relative to benchmarks (eg, aspirin at discharge: 78.6% vs 90% benchmark). The odds of ideal (ie, no contraindications) elderly candidates receiving various evidence-based AMI treatments were consistently less than that of non-elderly patients with AMI, with the exception of ACEIs at discharge (odds ratio, 1.46; 95% CI, 1.22-1.74).

CONCLUSIONS

Despite adjustments for contraindications to therapy, the underuse of AMI treatments, particularly in elderly patients, was found.

Authors+Show Affiliations

University of Toronto, Institute of Medical Sciences, Toronto, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15523314

Citation

Tran, Chau T T., et al. "Effect of Age On the Use of Evidence-based Therapies for Acute Myocardial Infarction." American Heart Journal, vol. 148, no. 5, 2004, pp. 834-41.
Tran CT, Laupacis A, Mamdani MM, et al. Effect of age on the use of evidence-based therapies for acute myocardial infarction. Am Heart J. 2004;148(5):834-41.
Tran, C. T., Laupacis, A., Mamdani, M. M., & Tu, J. V. (2004). Effect of age on the use of evidence-based therapies for acute myocardial infarction. American Heart Journal, 148(5), 834-41.
Tran CT, et al. Effect of Age On the Use of Evidence-based Therapies for Acute Myocardial Infarction. Am Heart J. 2004;148(5):834-41. PubMed PMID: 15523314.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of age on the use of evidence-based therapies for acute myocardial infarction. AU - Tran,Chau T T, AU - Laupacis,Andreas, AU - Mamdani,Muhammad M, AU - Tu,Jack V, PY - 2004/11/4/pubmed PY - 2005/3/2/medline PY - 2004/11/4/entrez SP - 834 EP - 41 JF - American heart journal JO - Am Heart J VL - 148 IS - 5 N2 - BACKGROUND: Previous studies have documented an underuse of evidence-based therapies in patients with acute myocardial infarction (AMI). However, many of these studies failed to consider contraindications to therapy, the effect of age (ie, elderly vs non-elderly patients) on use, or both. The objective of this study was to determine whether elderly patients are less likely than non-elderly patients to receive evidence-based AMI treatments, both before and after the consideration of contraindications to therapy. METHODS: A retrospective chart review of a random sample of 5131 patients with AMI who were admitted to 1 of 44 hospitals in Ontario was conducted for the fiscal years 1994 to 1996. Using the Canadian Cardiovascular Research Team (CCORT)/Canadian Cardiovascular Society (CCS) Quality Indicators for AMI Care, we classified patients as being eligible or ideal (ie, no contraindications to treatment) candidates to receive aspirin, beta-blockers, thrombolysis, angiotensin-converting enzyme inhibitors (ACEIs), or statins or to undergo lipid profiling. The proportions of eligible and ideal patients who received treatment were calculated, and the latter were compared with benchmarks. RESULTS: The median age of the cohort was 69 years; 63% were of the patients were aged > or =65 years. There was underperformance of prescribing treatments in ideal candidates relative to benchmarks (eg, aspirin at discharge: 78.6% vs 90% benchmark). The odds of ideal (ie, no contraindications) elderly candidates receiving various evidence-based AMI treatments were consistently less than that of non-elderly patients with AMI, with the exception of ACEIs at discharge (odds ratio, 1.46; 95% CI, 1.22-1.74). CONCLUSIONS: Despite adjustments for contraindications to therapy, the underuse of AMI treatments, particularly in elderly patients, was found. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/15523314/Effect_of_age_on_the_use_of_evidence_based_therapies_for_acute_myocardial_infarction_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002870304002911 DB - PRIME DP - Unbound Medicine ER -