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Acute myocardial infarction complicated by heart block in the elderly: prevalence and outcomes

S S Rathore1, B J Gersh, P B Berger

  • 1Division of Cardiology, Department of Medicine, Georgetown University Medical Center, Washington, DC 20007, USA.

American Heart Journal
|January 3, 2001
PubMed

Insights

Heart block (HB) is a common complication of acute myocardial infarction (MI) in elderly patients, increasing short-term mortality. However, HB does not impact long-term survival among hospital survivors.

Area of Science:

  • Cardiology
  • Geriatric Medicine
  • Internal Medicine

Background:

  • Second- and third-degree heart block (HB) are frequent conduction disorders following acute myocardial infarction (MI).
  • Patient characteristics and outcomes associated with HB in elderly populations require further definition.

Purpose of the Study:

  • To investigate the incidence and outcomes of heart block (HB) in elderly patients with acute myocardial infarction (MI).
  • To determine the association between HB and in-hospital and long-term mortality in this demographic.

Main Methods:

  • A retrospective analysis of 106,780 Medicare beneficiaries aged 65+ treated for acute MI (January 1994 - February 1996).
  • Comparison of HB and non-HB patient groups using univariate analysis.
  • Evaluation of HB's influence on outcomes via unadjusted and multiple logistic regression.

Main Results:

  • Heart block (HB) was documented in 4.7% of patients, more common in inferior MIs, especially with reperfusion therapy.
  • HB patients exhibited significantly higher in-hospital mortality (29.6% vs. 17.5%, P=.001).
  • HB independently predicted in-hospital mortality (RR 1.41), but not 1-year mortality (RR 0.94) among survivors. Mortality risks varied by MI location.

Conclusions:

  • Heart block (HB) is a prevalent complication of acute MI in the elderly, particularly with inferior MIs and reperfusion.
  • HB is an independent predictor of short-term mortality following acute MI.
  • HB does not significantly affect long-term mortality in hospital survivors of acute MI.
Abstract

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