Clinical InvestigationAcute Ischemic Heart DiseaseQuality of acute myocardial infarction care and outcomes in 33,997 patients aged 80 years or older: Findings from Get With The Guidelines-Coronary Artery Disease (GWTG-CAD)
Section snippets
Methods
The primary data were derived from the American Heart Association's GWTG-CAD registry. This initiative, promoting performance improvement strategies and higher adherence to national guidelines,11, 12, 13 was performed in different types of medical centers across the United States. Hospitals submitted patients' data without financial compensation, and data were entered by highly trained hospital staff. Cases were based on identification of patients with the diagnosis of AMI and stratified into
Patient characteristics
The study population included 156,677 patients admitted with AMI. From these, 45.3% (n = 70,907) were aged 18 to 64, 33.0% (n = 51,773) 65 to 79, and 21.7% were ≥80 years (n = 33,997). Older patients (≥80 years) were more likely to be women, white, and had lower body mass indices as shown in Table I, and tended to have higher prevalence of most comorbidities except for COPD, DM, high lipids, peripheral vascular disease, and smoking.
Clinical performance measures
ASA and BB utilization in the first 24 hours was high in the
Discussion
This study, based on one of the largest contemporary cohorts in the United States with a substantial proportion of older adults, demonstrates that patients ≥80 years presenting with AMI have higher comorbidites, longer reperfusion times, and lower revascularization procedures rates compared to younger patients. These differences persist after adjustment for baseline characteristics. In addition, after AMI, older adults are less likely to be discharged on medications, which have demonstrated to
Conclusions
Among hospitals participating in GWTG-CAD, there was high adherence with guideline-recommended therapies and significant improvements over time for patients ≥80 years old hospitalized with AMI. Nevertheless, there remain important gaps in care and outcomes for patients ≥80 years old after AMI. Older age group patients were less likely to receive mechanical reperfusion within 90 minutes and less likely to be discharged with ASA, BB, statins, and ACEi/ARB, even after controlling for other
Disclosures
Sources of Funding: GWTG-CAD is a program of the American Heart Association and is supported in part by an unrestricted educational grant from Merck/Schering-Plough Pharmaceutical and Pfizer. The analysis of registry data was performed at Duke Clinical Research Institute (Durham, NC), which receives funding from the American Heart Association. The sponsors were not involved in the design, analysis, preparation, review, or approval of this manuscript.
Hector M. Medina, MD: National Institutes of
References (34)
- et al.
Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials
Lancet
(2003) - et al.
ACC/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine
J Am Coll Cardiol
(2007) - et al.
ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction; a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of patients with acute myocardial infarction)
J Am Coll Cardiol
(2004) - et al.
Using “Get with the Guidelines” to improve cardiovascular secondary prevention
Jt Comm J Qual Saf
(2003) - et al.
Characteristics, management, and outcomes of 5,557 patients age > or = 90 years with acute coronary syndromes: results from the CRUSADE Initiative
J Am Coll Cardiol
(2007) - et al.
Impact of age on management and outcome of acute coronary syndrome: observations from the Global Registry of Acute Coronary Events (GRACE)
Am Heart J
(2005) - et al.
Randomized comparison of direct thrombin inhibition versus heparin in conjunction with fibrinolytic therapy for acute myocardial infarction: results from the GUSTO-IIb Trial. Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes (GUSTO-IIb) Investigators
J Am Coll Cardiol
(1998) - et al.
Promise of combined low-molecular-weight heparin and platelet glycoprotein IIb/IIIa inhibition: results from Platelet IIb/IIIa Antagonist for the Reduction of Acute coronary syndrome events in a Global Organization Network B (PARAGON B)
Am Heart J
(2002) - et al.
Single-bolus tenecteplase compared with front-loaded alteplase in acute myocardial infarction: the ASSENT-2 double-blind randomised trial
Lancet
(1999) - et al.
Trends in reperfusion strategies, door-to-needle and door-to-balloon times, and in-hospital mortality among patients with ST-segment elevation myocardial infarction enrolled in the National Registry of Myocardial Infarction from 1990 to 2006
Am Heart J
(2008)
Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective
Circulation
Long-term trends in myocardial infarction incidence and case fatality in the National Heart, Lung, and Blood Institute's Framingham Heart study
Circulation
Declining severity of myocardial infarction from 1987 to 2002: the Atherosclerosis Risk in Communities (ARIC) Study
Circulation
Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Fibrinolytic Therapy Trialists' (FTT) Collaborative Group
Lancet
Representation of elderly persons and women in published randomized trials of acute coronary syndromes
Jama
Heart disease and stroke statistics—2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Circulation
The State of Aging and Health in America Report 2007
Cited by (19)
Sex and Gender Disparities in the Management and Outcomes of Acute Myocardial Infarction–Cardiogenic Shock in Older Adults
2020, Mayo Clinic ProceedingsCitation Excerpt :Though not the focus in this study, our study is consistent with improved survival associated with PCI in this population of older AMI-CS admissions (adjusted OR, 0.65; 95% CI, 0.62-0.67; P<.001). In addition to PCI, older patients frequently receive delayed revascularization and lower rates of guideline-directed medical therapy during and after the acute care hospitalization.41 However, because this study was focused on older patients, we did not compare this cohort with the population younger than 75 years.
Validity of in-hospital mortality data among patients with acute myocardial infarction or stroke in National Health Insurance Research Database in Taiwan
2015, International Journal of CardiologyCitation Excerpt :The reduction of the in-hospital mortality rate of acute myocardial infarction (AMI) or stroke is an important quality indicator for hospital performance or procedures, such as percutaneous coronary intervention or thrombolytic therapy, among these patients [1–4]. Population-based administration or claims database are two valuable resources to perform epidemiological studies and healthcare quality evaluation [5,6]. Understanding the underlying diseases (e.g. AMI or stroke) of mortality events has significant clinical, economic, and quality-of-life implications.
Correlation between comprehensive evaluation of coronary artery lesion severity and long-term clinical outcomes in chinese octogenarians with acute coronary syndrome
2014, Heart Lung and CirculationCitation Excerpt :About 21.7% of AMI patients (n = 156,677) were ≥80 years old. Older patients had a higher prevalence of comorbidities compared with younger patients, and the mortality of the patients ≥80 years old was substantially higher compared with the youngest cohort [18,19]. Accordingly, it is very important to accurately evaluate the risk factors for coronary artery lesion severity in ACS patients > 80 years old, and to perform effective therapeutic interventions.
Effects of contemporary management on clinical outcomes in elderly patients with acute myocardial infarction
2013, International Journal of CardiologyEncouraging trends in acute myocardial infarction survival in the oldest old
2013, American Journal of MedicineCitation Excerpt :In the present study, we did not observe such a large increase in coronary reperfusion therapy use, suggesting that our findings are predominantly related to increased use of guideline-based medications. Similar results were reported in a study from the Get With The Guidelines–Coronary Artery Disease project, which included more than 30,000 patients with an acute coronary syndrome (mean age, 85 years) hospitalized at more than 400 US medical centers between 2002 and 2009.21 In this population, the use of evidence-based cardiac therapies during hospitalization increased significantly during the study period, whereas the in-hospital death rate declined.
Sorin J. Brener, MD, served as guest editor for this article.
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On behalf of the GWTG Steering Committee and Investigators.