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Evolution in cardiovascular care for elderly patients with non-ST-segment elevation acute coronary syndromes: results from the CRUSADE National Quality Improvement Initiative.
J Am Coll Cardiol 2005; 46(8):1479-87JACC

Abstract

OBJECTIVES

This study evaluated the impact of age on care and outcomes for non-ST-segment elevation acute coronary syndromes (NSTE ACS).

BACKGROUND

Recent clinical trials have expanded treatment options for NSTE ACS, now reflected in guidelines. Elderly patients are at highest risk, yet have previously been shown to receive less care than younger patients.

METHODS

In 56,963 patients with NSTE ACS at 443 U.S. hospitals participating in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) National Quality Improvement Initiative from January 2001 to June 2003, we compared use of guidelines-recommended care across four age groups: <65, 65 to 74, 75 to 84, and > or =85 years. A multivariate model tested for age-related differences in treatments and outcomes after adjusting for patient, provider, and hospital factors.

RESULTS

Of the study population, 35% were > or =75 years old, and 11% were > or =85 years old. Use of acute anti-platelet and anti-thrombin therapy within the first 24 h decreased with age. Elderly patients were also less likely to undergo early catheterization or revascularization. Whereas use of many discharge medications was similar in young and old patients, clopidogrel and lipid-lowering therapy remained less commonly prescribed in elderly patients. In-hospital mortality and complication rates increased with advancing age, but those receiving more recommended therapies had lower mortality even after adjustment than those who did not.

CONCLUSIONS

Age impacts use of guidelines-recommended care for newer agents and early in-hospital care. Further improvements in outcomes for elderly patients by optimizing the safe and early use of therapies are likely.

Authors+Show Affiliations

Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, North Carolina 27715, USA. alexa019@dcri.duke.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

16226171

Citation

Alexander, Karen P., et al. "Evolution in Cardiovascular Care for Elderly Patients With non-ST-segment Elevation Acute Coronary Syndromes: Results From the CRUSADE National Quality Improvement Initiative." Journal of the American College of Cardiology, vol. 46, no. 8, 2005, pp. 1479-87.
Alexander KP, Roe MT, Chen AY, et al. Evolution in cardiovascular care for elderly patients with non-ST-segment elevation acute coronary syndromes: results from the CRUSADE National Quality Improvement Initiative. J Am Coll Cardiol. 2005;46(8):1479-87.
Alexander, K. P., Roe, M. T., Chen, A. Y., Lytle, B. L., Pollack, C. V., Foody, J. M., ... Peterson, E. D. (2005). Evolution in cardiovascular care for elderly patients with non-ST-segment elevation acute coronary syndromes: results from the CRUSADE National Quality Improvement Initiative. Journal of the American College of Cardiology, 46(8), pp. 1479-87.
Alexander KP, et al. Evolution in Cardiovascular Care for Elderly Patients With non-ST-segment Elevation Acute Coronary Syndromes: Results From the CRUSADE National Quality Improvement Initiative. J Am Coll Cardiol. 2005 Oct 18;46(8):1479-87. PubMed PMID: 16226171.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evolution in cardiovascular care for elderly patients with non-ST-segment elevation acute coronary syndromes: results from the CRUSADE National Quality Improvement Initiative. AU - Alexander,Karen P, AU - Roe,Matthew T, AU - Chen,Anita Y, AU - Lytle,Barbara L, AU - Pollack,Charles V,Jr AU - Foody,Joanne M, AU - Boden,William E, AU - Smith,Sidney C,Jr AU - Gibler,W Brian, AU - Ohman,E Magnus, AU - Peterson,Eric D, AU - ,, Y1 - 2005/09/29/ PY - 2005/03/03/received PY - 2005/04/29/revised PY - 2005/05/03/accepted PY - 2005/10/18/pubmed PY - 2006/1/20/medline PY - 2005/10/18/entrez SP - 1479 EP - 87 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 46 IS - 8 N2 - OBJECTIVES: This study evaluated the impact of age on care and outcomes for non-ST-segment elevation acute coronary syndromes (NSTE ACS). BACKGROUND: Recent clinical trials have expanded treatment options for NSTE ACS, now reflected in guidelines. Elderly patients are at highest risk, yet have previously been shown to receive less care than younger patients. METHODS: In 56,963 patients with NSTE ACS at 443 U.S. hospitals participating in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) National Quality Improvement Initiative from January 2001 to June 2003, we compared use of guidelines-recommended care across four age groups: <65, 65 to 74, 75 to 84, and > or =85 years. A multivariate model tested for age-related differences in treatments and outcomes after adjusting for patient, provider, and hospital factors. RESULTS: Of the study population, 35% were > or =75 years old, and 11% were > or =85 years old. Use of acute anti-platelet and anti-thrombin therapy within the first 24 h decreased with age. Elderly patients were also less likely to undergo early catheterization or revascularization. Whereas use of many discharge medications was similar in young and old patients, clopidogrel and lipid-lowering therapy remained less commonly prescribed in elderly patients. In-hospital mortality and complication rates increased with advancing age, but those receiving more recommended therapies had lower mortality even after adjustment than those who did not. CONCLUSIONS: Age impacts use of guidelines-recommended care for newer agents and early in-hospital care. Further improvements in outcomes for elderly patients by optimizing the safe and early use of therapies are likely. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/16226171/Evolution_in_cardiovascular_care_for_elderly_patients_with_non_ST_segment_elevation_acute_coronary_syndromes:_results_from_the_CRUSADE_National_Quality_Improvement_Initiative_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(05)01768-7 DB - PRIME DP - Unbound Medicine ER -