Encouraging trends in acute myocardial infarction survival in the oldest old
Jennifer Tjia1, Jeroan Allison, Jane S Saczynski
1Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA. jennifer.tjia@umassmed.edu
Insights
Increased guideline-based cardiac medication use improved 90-day survival for elderly patients (≥85 years) hospitalized with acute myocardial infarction (AMI) between 1997 and 2007.
Area of Science:
- Geriatric Cardiology
- Cardiovascular Medicine
- Clinical Pharmacology
Background:
- Optimal treatment strategies for acute myocardial infarction (AMI) in the oldest old (≥85 years) are not well-defined.
- Limited data exist regarding the impact of guideline-based cardiac medications on mortality in this specific demographic.
- Investigating the role of medication trends in improving survival for elderly AMI patients is crucial.
Purpose of the Study:
- To examine if increased use of guideline-based cardiac medications mediates improved post-discharge survival in oldest old patients hospitalized with AMI.
- To analyze trends in medication prescribing and survival rates over a decade in this vulnerable population.
Main Methods:
- A population-based study included 1137 patients aged ≥85 years hospitalized for AMI between 1997 and 2007.
- Trends in 90-day post-discharge survival and use of guideline-based medications (aspirin, ACE inhibitors/ARBs, beta-blockers, statins) were assessed.
- Multivariable Cox regression models analyzed the relationship between medication use, study year, and survival.
Main Results:
- Patients hospitalized between 2003-2007 showed significantly higher 90-day survival (69.1%) compared to 1997-2001 (59.8%).
- The average number of discharge medications increased from 1.8 to 2.9 between 1997 and 2007 (P < .001).
- Increased medication use explained the improved survival trend, as the association became non-significant after adjustment.
Conclusions:
- A significant improvement in 90-day survival was observed for patients aged ≥85 years hospitalized with AMI from 1997 to 2007.
- This survival benefit is attributed to the increased prescription of guideline-based cardiac medications during this period.
- Adherence to guideline-based therapies is vital for improving outcomes in elderly AMI patients.
Background:
There are limited data informing the optimal treatment strategy for acute myocardial infarction in the oldest old (aged ≥85 years). The study aim was to examine whether decade-long increases in guideline-based cardiac medication use mediate declines in post-discharge mortality among oldest old patients hospitalized with acute myocardial infarction.
Methods:
The study sample included 1137 patients aged ≥85 years hospitalized in 6 biennial periods between 1997 and 2007 for acute myocardial infarction at all 11 greater Worcester, Massachusetts, medical centers. We examined trends in 90-day survival after hospital discharge and guideline-based medication use (aspirin, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers, lipid-lowering agents) for acute myocardial infarction during hospitalization and at discharge. Sequential multivariable Cox regression models examined the relationship among guideline-based medication use, study year, and 90-day post-discharge survival rates.
Results:
Patients hospitalized between 2003 and 2007 experienced higher 90-day survival rates than those hospitalized between 1997 and 2001 (69.1% vs 59.8%, P < .05). Between 1997 and 2007, the average number of guideline-based medications prescribed at discharge increased significantly (1.8 to 2.9, P < .001). The unadjusted hazard ratio for 90-day post-discharge mortality in 2003-2007 compared with 1997-2001 was 0.73 (95% confidence interval, 0.60-0.89); after adjustment for patient characteristics and guideline-based cardiac medication use, this relationship was no longer significant (hazard ratio, 1.26; 95% confidence interval, 1.00-1.58).
Conclusions:
Between 1997 and 2007, 90-day survival improved among a population-based sample of patients aged ≥85 years hospitalized for acute myocardial infarction. This encouraging trend was explained by increased use of guideline-based medications.
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