Key result
Elderly patients (≥75 years) with ACS were less likely to receive reperfusion for ST-elevation (OR 0.53; 95% CI 0.42-0.67) and had higher in-ICCU mortality than younger patients.
Why the study?
Does older age (≥75 years) impact the receipt of guideline-recommended care and in-ICCU mortality in patients with acute coronary syndromes?
Observational (n=3,636)
Yes
Does older age (≥75 years) impact the receipt of guideline-recommended care and in-ICCU mortality in patients with acute coronary syndromes?
Odds Ratio: 0.53 (95% CI 0.42–0.67)
Elderly patients with ACS admitted to Italian ICCUs have a higher risk profile and higher mortality, yet are significantly less likely to receive guideline-recommended invasive care and reperfusion compared to younger patients.
Disparities in reperfusion may signal care gaps for elderly ACS; leaves open whether age-specific strategies could narrow mortality differences.
BACKGROUND: Guideline-recommended therapies for acute coronary syndromes (ACS) derive from randomized trials in which elderly patients are underrepresented. Although numbers of this population are increasing, they are largely undertreated in the real world. OBJECTIVE: The study evaluates the impact of older age on care for patients with ACS admitted to the Italian Intensive Cardiac Care Units (ICCUs) network. METHODS: We analyzed data from the BLITZ-3 Registry in order to assess in-hospital care among unselected elderly patients (≥75 years). RESULTS: From 7-20 April 2008, 6986 consecutive patients with acute cardiac conditions were admitted to ICCUs and prospectively enrolled; 3636 (52%) had ACS and 38% of them were elderly. Elderly patients had a higher risk profile, their median length of stay in ICCU was longer [4 days, interquartile range (IQR): 3-6 vs. 3 days, IQR: 2-5; P < 0.0001] and guideline-recommended care was applied less often. At multivariable analysis, elderly patients were less likely to receive reperfusion [odds ratio (OR) = 0.53, 95% confidence interval (CI) = 0.42-0.67] for ST-elevation, or early coronary angiography (OR = 0.45, 95% CI = 0.37-0.56) for non-ST elevation ACS. Besides, unadjusted in-ICCU total mortality was higher for elderly patients with ST-elevation (11.8% elderly vs. 1.8% younger patients; P < 0.0001) or non-ST-elevation (3.9% elderly vs. 0.6% younger patients; P < 0.0001) ACS. CONCLUSION: In a nationwide survey, age impacts on care. The elderly with ACS have a higher risk profile but receive less guideline-recommended care than younger patients. Thus, further improvements in care of this population should be pursued.
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Casella et al. (2012) conducted an observational in Acute coronary syndromes (n=3,636). Older age (≥75 years) vs. Younger patients (<75 years) was evaluated on Reperfusion for ST-elevation ACS (OR 0.53, 95% CI 0.42-0.67). Elderly patients (≥75 years) with ACS were less likely to receive reperfusion for ST-elevation (OR 0.53; 95% CI 0.42-0.67) and had higher in-ICCU mortality than younger patients.
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