Post-myocardial infarction risk stratification in elderly patients
Karen P. Alexander, Anthony N. Galanos, James G. Jollis, Judith A. Stafford, Eric D. Peterson
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 ≥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 ≥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.
American heart journal
https://doi.org/10.1067/mhj.2001.115589
10.1067/mhj.2001.115589
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Myocardial Infarction Medicine & Life Sciences 100%
Left Ventricular Function Medicine & Life Sciences 50%
Medicare Part A Medicine & Life Sciences 29%
Cardiac Catheterization Medicine & Life Sciences 17%
Alexander, K. P., Galanos, A. N., Jollis, J. G., Stafford, J. A., & Peterson, E. D. (2001). Post-myocardial infarction risk stratification in elderly patients. American heart journal, 142(1), 37-42. https://doi.org/10.1067/mhj.2001.115589
Post-myocardial infarction risk stratification in elderly patients. / Alexander, Karen P.; Galanos, Anthony N.; Jollis, James G. et al.
In: American heart journal, Vol. 142, No. 1, 2001, p. 37-42.
Alexander, KP, Galanos, AN, Jollis, JG, Stafford, JA & Peterson, ED 2001, 'Post-myocardial infarction risk stratification in elderly patients', American heart journal, vol. 142, no. 1, pp. 37-42. https://doi.org/10.1067/mhj.2001.115589
Alexander KP, Galanos AN, Jollis JG, Stafford JA, Peterson ED. Post-myocardial infarction risk stratification in elderly patients. American heart journal. 2001;142(1):37-42. doi: 10.1067/mhj.2001.115589
Alexander, Karen P. ; Galanos, Anthony N. ; Jollis, James G. et al. / Post-myocardial infarction risk stratification in elderly patients. In: American heart journal. 2001 ; Vol. 142, No. 1. pp. 37-42.
@article{128e885045b04c0287218ed86c9b4377,
title = "Post-myocardial infarction risk stratification in elderly patients",
abstract = "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 ≥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 ≥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.",
author = "Alexander, {Karen P.} and Galanos, {Anthony N.} and Jollis, {James G.} and Stafford, {Judith A.} and Peterson, {Eric D.}",
doi = "10.1067/mhj.2001.115589",
journal = "American Heart Journal",
T1 - Post-myocardial infarction risk stratification in elderly patients
AU - Alexander, Karen P.
AU - Galanos, Anthony N.
AU - Jollis, James G.
AU - Stafford, Judith A.
AU - Peterson, Eric D.
N2 - 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 ≥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 ≥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.
AB - 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 ≥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 ≥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.
U2 - 10.1067/mhj.2001.115589
DO - 10.1067/mhj.2001.115589
JO - American Heart Journal
JF - American Heart Journal