(Circulation. 1995;92:2841-2847.)
© 1995 American Heart Association, Inc.
Articles |
Aspirin in the Treatment of Acute Myocardial Infarction in Elderly Medicare Beneficiaries
Patterns of Use and Outcomes
From the Section of Cardiovascular Medicine, Department of Medicine, and
the Section of Chronic Disease Epidemiology, Department of Epidemiology and
Public Health, Yale School of Medicine, New Haven, Conn (H.M.K.); the
Connecticut Peer Review Organization, Middletown (H.M.K., M.J.R., J.H.,
T.P.M., M.P., Y.W.); the Cardiology Division, Department of Medicine,
University of Connecticut Medical School, Farmington (M.J.R.); the Department
of Surgery, University of Iowa College of Medicine, Iowa City, and Iowa Peer
Review Organization, West Des Moines (T.F.K.); and the Health Care Financing
Administration,
1 Baltimore, Md (E.F.E., S.F.J.).
Background Although aspirin is an effective, inexpensive, and safe treatment of acute myocardial infarction, the frequency of use of aspirin in actual medical practice is not known. Elderly patients, a group with low rates of utilization of effective therapies such as thrombolytic therapy, also may be at risk of not receiving aspirin for acute myocardial infarction. To address this issue, we sought to determine the current pattern of aspirin use and to assess its effectiveness in a large, population-based sample of elderly patients hospitalized with acute myocardial infarction.
Methods and Results As part of the Cooperative
Cardiovascular Project Pilot, a Health Care
Financing Administration initiative to improve quality of care for
Medicare beneficiaries, we abstracted hospital medical records of
Medicare beneficiaries who were hospitalized in Alabama, Connecticut,
Iowa, or Wisconsin from June 1992 through February 1993. Among the
10 018 patients 
65 years old who had no absolute contraindications
to aspirin, 6140 patients (61%) received aspirin within the first 2
days of hospitalization. Patients who were older, had more comorbidity,
presented without chest pain, and had high-risk
characteristics such as heart failure and shock were less likely to
receive aspirin. The use of aspirin was significantly associated with a
lower mortality (OR, 0.78; 95% CI, 0.70 to 0.89) after adjustment for
potential confounders.
Conclusions About one third of elderly patients with acute myocardial infarction who had no contraindications to aspirin therapy did not receive it within the first 2 days of hospitalization. The elderly patients with the highest risk of death were the least likely to receive aspirin. After adjustment for differences between the treatment groups, the use of aspirin was associated with 22% lower odds of 30-day mortality. The increased use of aspirin for patients with acute myocardial infarction is an excellent opportunity to improve the delivery of care to elderly patients.
Key Words: aspirin • myocardial infarction • aging
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