June 4, 1997JAMA
Thrombolytic Therapy for Eligible Elderly Patients With Acute Myocardial Infarction
Why the study?
What are the predictors of not receiving thrombolytic therapy in eligible elderly patients hospitalized with acute myocardial infarction?
Population
A cohort of 3,093 patients aged 65 years and older with a discharge diagnosis of acute myocardial infarction…
Comparison
Thrombolytic therapy vs No thrombolytic therapy
Design
Cohort
Authors
Discussion
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Implication
Predictors of thrombolytic non-use in eligible elderly AMI patients merit attention in decision-making; leaves open whether addressing them improves outcomes.
Key Points
- The study aims to identify factors influencing the use of thrombolytic therapy in elderly patients hospitalized with acute myocardial infarction.
- Retrospective cohort study utilizing medical charts and administrative files from all acute care hospitals in Connecticut.
- Involved 3093 patients aged 65 and older with a discharge diagnosis of acute myocardial infarction covered by Medicare.
- Analyzed predictors of thrombolytic therapy not administered among eligible patients.
- Among 753 eligible patients with ST-segment elevation, 419 (56%) did not receive thrombolytic therapy.
- Main predictors for not receiving therapy included advanced age and delayed presentation, impacting clinical decision-making.
- Among 261 patients presenting with chest pain within 6 hours of symptoms, 197 (75%) received thrombolytic therapy.
Structured PICO
What are the predictors of not receiving thrombolytic therapy in eligible elderly patients hospitalized with acute myocardial infarction?
P
Population
A cohort of 3,093 patients aged 65 years and older with a discharge diagnosis of acute myocardial infarction covered by Medicare from May 1992 to May 1993 in Connecticut. The primary analysis focused on a subset of 753 eligible patients with ST-segment elevation of 1 mm or more in at least 2 contiguous leads, left bundle branch block not known to be old, and no absolute contraindications to thrombolytic therapy who were not referred for direct angioplasty or bypass surgery.
I
Intervention
Thrombolytic therapy
C
Comparator
No thrombolytic therapy
O
Outcome
Use of thrombolytic therapy
More than half of eligible elderly patients with acute myocardial infarction did not receive thrombolytic therapy, largely driven by clinical judgments regarding bleeding risk, lower-risk infarction, and diagnostic uncertainty.
Cite This Study
Harlan M. Krumholz (1997) studied this question.