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September 26, 2008European Heart JournalOpen Access

Changes in management of elderly patients with myocardial infarction

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Key result

Admission in 2005-2006 was associated with increased use of guideline-recommended treatments and lower 1-month mortality compared to 2000-2001 (7.1% vs 13.6%, P=0.001).

Why the study?

Does increased use of guideline-recommended treatments reduce 1-month mortality in elderly patients with acute myocardial infarction?

Population

868 elderly patients (≥75 years) admitted for acute myocardial infarction (MI)

Comparison

Management between October 2005 and October… vs Management between October 2000 and March 2001

Design

Cohort

Follow-up

1 month

Authors

FSFrançois SchieleNMNicolas MéneveauMSMarie‐France Seronde

Discussion

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Overview

Associated lower 30-day mortality with greater guideline adherence in elderly AMI; leaves open whether treatment changes drove the improvement.

Key Points

  • To assess changes in the utilization of guideline-recommended therapies between 2001 and 2006 among elderly patients hospitalized with acute myocardial infarction and evaluate their association with 1-month mortality.
  • Prospective, multicenter registry analyzing 868 elderly patients (≥75 years) admitted during two periods: cohort 1 (N=280; Oct 2000–Mar 2001) and cohort 2 (N=588; Oct 2005–Oct 2006).
  • Assessed in-hospital treatments—including reperfusion/early invasive therapy, oral antiplatelets, anticoagulants, ACE-inhibitors, beta-blockers, and statins—and 1-month survival using propensity score adjustment and multivariable modeling.
  • Cohort 2 showed a significant increase in the use of aspirin, clopidogrel, reperfusion therapy, ACE-inhibitors, and statins compared with cohort 1.
  • One-month mortality was significantly lower in cohort 2 than in cohort 1 (7.1% vs. 13.6%, P = 0.001), primarily driven by a marked reduction in patients with ST-segment elevation MI (9.2% vs. 23.3%, P < 0.001).
  • Multivariable analysis indicated that the three-fold higher mortality rate initially observed in cohort 1 was eliminated once treatment intensity was incorporated into the model.

Study Design

Type

Cohort (n=868)

Multicenter

Yes

Structured PICO

Does increased use of guideline-recommended treatments reduce 1-month mortality in elderly patients with acute myocardial infarction?

P
Population
868 elderly patients (≥75 years) admitted for acute myocardial infarction, comparing cohorts from 2000-2001 and 2005-2006 for 1-month survival.
E
Exposure
Management between October 2005 and October 2006 (cohort 2), characterized by increased use of guideline-recommended treatments including aspirin, clopidogrel, reperfusion therapy, ACE-inhibitors, and statins
C
Comparator
Management between October 2000 and March 2001 (cohort 1)
O
Outcome
1-month mortalityhard clinical

Main Result

Absolute Event Rate: 7.1% vs 13.6%

p-value: p=0.001

Increased adherence to guideline-recommended treatments for acute MI in elderly patients over a 5-year period was associated with a significant reduction in 30-day mortality.

Cite This Study

Schiele et al. (2008) conducted a cohort in acute myocardial infarction (n=868). Admission in 2005-2006 (Cohort 2) vs. Admission in 2000-2001 (Cohort 1) was evaluated on 1-month mortality (p=0.001). Admission in 2005-2006 was associated with increased use of guideline-recommended treatments and lower 1-month mortality compared to 2000-2001 (7.1% vs 13.6%, P=0.001).

synapsesocial.com/papers/6a9465848a4c78aef331a63ehttps://doi.org/10.1093/eurheartj/ehn601
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