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Differences in the Treatment of Patients with Acute Myocardial Infarction According to Patient Age
Author(s) -
Rosenthal Gary E.,
Fortinsky Richard H.
Publication year - 1994
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1994.tb06553.x
Subject(s) - medicine , myocardial infarction , comorbidity , logistic regression , retrospective cohort study , medical record , geriatrics , emergency medicine , psychiatry
OBJECTIVE : To identify age‐related differences in the treatment of patients with acute myocardial infarction. DESIGN : Retrospective cohort study. SETTING : Two university‐affiliated medical centers with integrated clinical programs. PATIENTS : 329 patients admitted with acute myocardial infarction in 1988–1990 for whom complete medical records were available. Study exclusions included patients transferred from other hospitals specifically to undergo angiography or other cardiac procedures, nursing home residents, patients with metastatic cancer or dementia, and patients in whom “do not resuscitate” orders were written during the first 2 hospital days. MEASUREMENTS : Medical records were reviewed to determine socio‐demographic data, comorbidity, admission severity of illness, medications, the use of specific diagnostic and therapeutic modalities during and after hospitalization, treatment limitations, and patient outcomes. MAIN RESULTS : Chronological age of patients was related to the use of several diagnostic and therapeutic modalities. Using logistic regression to adjust for comorbidity, severity, infarct size and location, and other covariates, patients 75 years and older were 12 times less likely to receive thrombolytic therapy, 8 times less likely to undergo coronary angiography, and 7 times less likely to undergo coronary angioplasty than patients less than 65 years of age. However, age was not related to the use of other modalities, including echocardiography or gated blood pool scanning, pulmonary artery catheterization, and transvenous pacing. Finally, in a logistic regression model, the risk of in‐hospital death was 4 times greater for patients 75 years and older than patients less than 65 years. CONCLUSIONS : Physicians' management of patients with acute myocardial infarction differed greatly according to patient age for some diagnostic and therapeutic modalities, but not for others. These findings indicate that generalizations about age‐related practice variations should not be based on analysis of a single procedure. Moreover, judgments about the appropriateness of age‐related differences in management require knowledge of the relative effectiveness of management strategies in older and younger patients.