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Varying thrombolytic administration rates in elderly patients with acute myocardial infarction
1Department of Medicine, Leeds General Infirmary.
Insights
Elderly patients with acute myocardial infarction admitted to geriatric wards received less thrombolytic therapy. Initial hospital admission location significantly impacted treatment for older adults with heart attacks.
Area of Science:
- Cardiology
- Geriatric Medicine
- Clinical Research
Background:
- Acute myocardial infarction (AMI) is a leading cause of mortality in the elderly.
- Timely reperfusion therapy, including thrombolysis, is crucial for improving outcomes in AMI.
- Elderly patients present unique challenges in diagnosis and treatment of AMI.
Purpose of the Study:
- To evaluate the impact of initial hospital admission unit on the receipt of thrombolytic therapy in elderly patients (≥75 years) with confirmed AMI.
- To compare thrombolytic therapy and aspirin administration rates between patients admitted to the Coronary Care Unit (CCU) and Geriatric Medical Ward (GMW).
Main Methods:
- Retrospective study analyzing data from patients aged 75 or over admitted with AMI.
- Comparison of thrombolysis and aspirin administration between CCU and GMW admissions.
- Analysis of documented contraindications for non-administration of therapies.
Main Results:
- Patients admitted to the CCU had significantly higher rates of thrombolytic therapy (56%) compared to GMW admissions (26%).
- A higher proportion of GMW admissions failed to receive thrombolysis without a documented contraindication (38% vs 9% in CCU).
- Aspirin administration was also more frequent in CCU admissions (78%) versus GMW (62%), though the difference in non-administration without contraindication was not significant.
Conclusions:
- Initial admission to a GMW, rather than a CCU, is associated with reduced receipt of essential thrombolytic therapy in elderly AMI patients.
- Systemic factors related to initial patient placement can create disparities in time-sensitive cardiac treatments for vulnerable elderly populations.
- Optimizing patient pathways and ensuring equitable access to specialized care are critical for improving outcomes in elderly patients with acute myocardial infarction.
Abstract:
Receipt of thrombolytic therapy in patients aged 75 or over with proven acute myocardial infarction admitted initially to either the coronary care unit (CCU) or a geriatric medical ward (GMW) was studied retrospectively in a hospital administering thrombolysis only in the CCU. Mean age and age distribution of patients admitted to each unit initially showed no significant difference. Of 50 patients admitted directly to the CCU, 28 (56%) received thrombolysis, compared with 13 of 50 (26%) GMW admissions (P < 0.02). Of 37 GMW admissions, 14 (38%) failed to receive thrombolysis without documented contraindication compared with 2 of 22 (9%) CCU admissions (P < 0.05). Aspirin was administered in 39 (78%) CCU and 31 (62%) GMW admissions (P < 0.05). Non-administration of aspirin without apparent contraindication occurred in 3 of 11 (27%) compared with 8 of 19 (42%) GMW admissions (NS). Elderly patients thus failed to receive thrombolytic therapy as a result of initial admission to a unit unable to administer this treatment.