February 1, 1996Annals of Internal Medicine
Aspirin for Secondary Prevention after Acute Myocardial Infarction in the Elderly: Prescribed Use and Outcomes
Why the study?
Does aspirin prescribed at hospital discharge improve 6-month survival in elderly patients surviving an acute myocardial infarction?
Population
5,490 consecutive Medicare beneficiaries aged 65 years and older who survived an acute myocardial infarction…
Comparison
Aspirin prescribed at hospital discharge. vs No aspirin prescribed at hospital discharge.
Design
Cohort
Follow-up
6 months
Authors
Discussion
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Member takes
Implication
Supports aspirin at discharge for elderly AMI survivors; leaves open causality and requires randomized confirmation before changing practice.
Key Points
- To evaluate the frequency of discharge aspirin prescriptions, identify factors influencing prescription decisions, and assess 6-month survival outcomes among elderly patients hospitalized with acute myocardial infarction.
- Observational study reviewing medical records of 5,490 consecutive Medicare beneficiaries aged 65 and older who survived an acute myocardial infarction without aspirin contraindications across 352 nongovernment acute care hospitals in four US states.
- Multivariable analysis was used to identify clinical factors associated with aspirin prescription at discharge and to evaluate its independent relationship with 6-month mortality.
- Aspirin was prescribed at hospital discharge to 4,149 of 5,490 eligible patients (76%), with prescription linked to better baseline health (higher left ventricular ejection fraction, absence of diabetes) and receipt of other cardiac therapies.
- Prescription of aspirin at discharge was associated with a significant reduction in 6-month mortality compared with no prescription (OR 0.77; 95% CI, 0.61 to 0.98).
Structured PICO
Does aspirin prescribed at hospital discharge improve 6-month survival in elderly patients surviving an acute myocardial infarction?
P
Population
5,490 consecutive Medicare beneficiaries aged 65 years and older who survived an acute myocardial infarction and did not have a contraindication to aspirin.
I
Intervention
Aspirin prescribed at hospital discharge.
C
Comparator
No aspirin prescribed at hospital discharge.
O
Outcome
Mortality rate 6 months after discharge (6-month survival).hard clinical
Aspirin prescription at discharge for elderly AMI survivors is associated with significantly improved 6-month survival, yet remains underutilized in eligible patients.
Cite This Study
Harlan M. Krumholz (1996) studied this question.