Trends in outcomes among older patients with non-ST-segment elevation myocardial infarction.

Abstract

OBJECTIVES:

The objective of this study is to assess trends in evidence-based therapy use and short- and long-term mortality over time among older patients with non-ST-segment elevation myocardial infarction (NSTEMI).

BACKGROUND:

With the prevalence of national quality improvement efforts, the use of evidence-based therapies has improved over time among patients with NSTEMI, yet it is unclear whether these improvements have been associated with significant change in short- and long-term mortality for older patients.

METHODS:

We linked detailed clinical data for 28,603 NSTEMI patients aged ≥65 years at 171 hospitals in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines Registry with longitudinal Centers for Medicare & Medicaid claims data and compared trends in annual unadjusted and risk-adjusted inhospital and long-term mortality from 2003 to 2006.

RESULTS:

The median age of our NSTEMI study population was 77 years, 48% were female, and 87% were white. Overall, inhospital and 1-year mortality rates were 6.0% and 24.5%, respectively. When compared with patients treated in 2003, NSTEMI patients treated in 2006 were more likely to receive guideline-recommended inhospital medications and early invasive treatment. Inhospital mortality decreased significantly over the study period (5.5% vs 7.2% [adjusted odds ratio 0.82, 95% CI 0.67-1.00, P = .045] for 2006 vs 2003), but there was no significant change in 1-year mortality from the index admission (24.0% vs 26.0% [adjusted hazard ratio 0.99, 95% CI 0.90-1.08] for 2006 vs 2003).

CONCLUSIONS:

Between 2003 and 2006, there was a significant reduction in inhospital mortality that corresponded to an increase in the use of evidence-based NSTEMI care. Nevertheless, long-term outcomes have not changed over time, suggesting a need for improved care transition and longitudinal secondary prevention.

• Authors: Chee Tang Chin, Tracy Y Wang, Anita Y Chen, Robin Mathews, Karen P Alexander, Matthew T Roe, Eric D Peterson
• Journal: American heart journal (Am Heart J) Vol. 167 Issue 1 Pg. 36-42.e1 (Jan 2014) ISSN: 1097-6744 [Electronic] United States
• PMID: 24332140 (Publication Type: Journal Article, Observational Study)
• Copyright: © 2014 Mosby, Inc. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Cardiology (standards)
• Evidence-Based Medicine
• Female
• Guideline Adherence
• Hospital Mortality
• Humans
• Male
• Myocardial Infarction (drug therapy, mortality, prevention & control, therapy)
• Prognosis
• Quality Improvement
• Registries
• Secondary Prevention
• Treatment Outcome