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[Acute myocardial infarction in elderly patients: medical and social problems]
M Kagoshima1, Y Miyashita, K Takei
1Division of Cardiology, Komoro Kosei General Hospital, Nagano.
Insights
Elderly patients with acute myocardial infarction (AMI) have poorer outcomes due to lower reperfusion rates, especially angioplasty. Early reperfusion, mobilization, and discharge are recommended for better prognosis in this population.
Area of Science:
- Cardiology
- Geriatric Medicine
- Public Health
Background:
- Acute myocardial infarction (AMI) incidence is rising in elderly populations.
- Treatment strategies for AMI in older adults remain a subject of debate.
- Pre-hospital factors like performance and living status significantly impact elderly AMI patient care.
Purpose of the Study:
- To compare in-hospital outcomes between elderly (≥70 years) and younger (<70 years) AMI patients.
- To analyze pre-hospital performance and living status in elderly AMI patients.
- To identify factors influencing prognosis and treatment efficacy in elderly AMI patients.
Main Methods:
- Retrospective analysis of 310 consecutive AMI patients.
- Division into elderly (≥70 years) and younger (<70 years) groups for outcome comparison.
- Review of pre-hospital performance and living status for elderly patients.
Main Results:
- Elderly patients received acute reperfusion therapy less frequently (60.8% vs 71.9%), particularly direct coronary angioplasty (28.6% vs 54.7%).
- Reperfusion success rates were lower in the elderly (74.8% vs 86.8%).
- Elderly patients experienced higher rates of in-hospital death, pulmonary edema, cardiogenic shock, pneumonia, and delirium.
Conclusions:
- Lower acute reperfusion rates, especially angioplasty, correlate with poorer prognosis and functional status in elderly AMI patients.
- Delirium affects treatment candidacy for approximately 30% of elderly patients.
- Recommendations include rapid reperfusion, early mobilization, and prompt discharge for elderly AMI patients.
Abstract:
The number of elderly patients with acute myocardial infarction has been increasing. However, the choice of treatment remains controversial. Medical records of 310 consecutive patients with acute myocardial infarction were reviewed. Two retrospective analyses were performed. 1) Patients were divided into the elderly group(70 years or more) and the younger group(under 70 years). In-hospital course and outcome were compared. 2) Pre-hospital performance status and living status were reviewed in the elderly group. Acute phase reperfusion therapy was performed in fewer patients in the elderly group(60.8% vs 71.9%, p < 0.01). The difference was most pronounced in cases of direct coronary angioplasty(28.6% vs 54.7%, p < 0.05). As a result, the rate of reperfusion success(74.8% vs 86.8%, p < 0.01) was lower in the elderly group. Moreover, the rates of in-hospital death(23.6% vs 6.8%, p < 0.005), pulmonary edema(20.3% vs 10.8%, p < 0.05), cardiogenic shock(11.9% vs 6.0%, p < 0.005), pneumonia(17.3% vs 3.0%, p < 0.005), and delirium(29.4% vs 12.0%, p < 0.001) were higher in the elderly group. Five patients in the elderly group and 3 patients in the younger group required rehabilitation because of worsened performance status. Six of them were non-reperfused patients. Elderly patients considered likely to become bed-ridden because of pre-existing physical disability at admission accounted for 28.9% of the total. Moreover, many elderly patients had poor support systems (8.4% were living alone, 21.0% were living only with their spouse or a child, 30.1% were widows or widowers). These results show that a lower acute phase reperfusion rate(especially angioplasty) resulted in a poor prognosis and worse performance status in elderly patients. Also 30% of patients were not good candidates for conventional treatment because of delirium, and that self-help in daily life is a fundamental goal for most elderly patients. Rapid and simple acute phase reperfusion, subsequent immediate mobilization, and early discharge are recommended for elderly patients with acute myocardial infarction.