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Post-myocardial infarction risk stratification in elderly patients
K P Alexander1, A N Galanos, J G Jollis
1Outcomes Research and Assessment Group, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA. karen.alexander@mc.duke.edu
Insights
Elderly patients receive less post-myocardial infarction (MI) risk stratification testing than younger patients. This age-related decline in cardiac testing may limit therapeutic interventions for older individuals at high risk.
Area of Science:
- Cardiology
- Geriatric Medicine
- Health Services Research
Background:
- Post-myocardial infarction (MI) risk stratification is recommended by expert panels.
- Limited data exist on the actual utilization of recommended post-MI testing.
- Concerns raised about under-referral of elderly patients for post-MI testing despite their high risk.
Purpose of the Study:
- To examine the utilization of post-myocardial infarction (MI) risk stratification in the elderly population.
- To assess whether elderly patients are referred for suggested post-MI testing as often as younger patients.
Main Methods:
- Retrospective analysis of Medicare records for 192,311 patients aged 65 years or older admitted with MI (Jan-Nov 1992).
- Combined Medicare Part A and B data to create longitudinal patient care records within 60 days of MI.
- Described patterns of post-MI testing for ischemia, left ventricular function, and outcomes based on patient age.
Main Results:
- Patients aged 75 and older were significantly less likely to undergo cardiac catheterization (17% vs. 43%) or coronary artery disease severity testing (24% vs. 53%) compared to those aged 65-74.
- Older patients (≥75 years) were also less likely to have left ventricular function tests (61% vs. 76%).
- Even after adjusting for baseline characteristics, older patients showed lower odds of coronary artery disease severity assessment (OR, 0.44) and left ventricular function testing (OR, 0.65).
Conclusions:
- Post-MI risk stratification testing significantly declines with increasing age in Medicare patients.
- Testing rates in the elderly fall below recommended guidelines, potentially missing opportunities for intervention.
- Age-related disparities in cardiac testing may lead to suboptimal management for high-risk elderly patients post-MI.
Background:
The purpose of this study was to examine the use of post-myocardial infarction (MI) risk stratification in the elderly. Although expert panels have recommended risk stratification after MI, limited data are available on whether patients actually undergo suggested testing. In particular, concern has been raised that the elderly, who are at high risk for recurrent ischemia and short-term death, are not referred as often as younger patients for post-MI testing.
Methods:
We studied the records of 192,311 Medicare patients (age > or = 65 years) admitted with MI between January 1992 and November 1992. By combining Medicare part A and part B data, we created a longitudinal record of patient care within 60 days of an MI admission. We describe the pattern of post-MI testing for ischemia and left ventricular function and outcomes as a function of patient age.
Results:
Patients > or = 75 years of age were significantly less likely than patients 65 to 74 years of age to have either cardiac catheterization (17% vs 43%) or any test for coronary artery disease severity (24% vs 53%). They were also less likely to have a test of left ventricular function (61% vs 76%). Even after adjustment for baseline characteristics, older patients remained less likely than younger patients to have an assessment of coronary artery disease severity (odds ratio, 0.44) or left ventricular function (odds ratio, 0.65).
Conclusions:
Post-MI risk stratification declines with age and falls short of recommendations in our nation's elderly. This lack of testing may result in lost opportunities for therapeutic interventions in this high-risk group.
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