Abstract 5596: Temporal Changes in Management of Elderly Patients with Myocardial Infarction: Impact on Mortality
Background: Elderly patients (>75 years) admitted for acute myocardial infarction (MI) are at higher risk for mortality. Despite this, elderly patients often receive fewer effective therapies, partially because they have more frequent contra indications or because they are at higher risk for drug induced adverse events. Increase in use of effective treatments over time and its impact on 1 month mortality are poorly documented.
Methods: A prospective multicenter registry was designed, including all (10) cardiology centers of the Franche-Comte region of France (1.2 million inhabitants). Demographic and clinical characteristics at admission, in-hospital treatment (invasive therapy, antiplatelets, ACE inhibitors, betablockers and statins) and one month survival were compared between two periods (2000, cohort 1, and 2005, cohort 2). Comparisons were adjusted on a propensity score for being admitted in 2000.
Results: In total, 2091 patients were included: 676 patients in cohort 1 (323 STEMI and 353 NSTEMI), and 1415 patients in cohort 2 (657 STEMI and 758 NSTEMI). Elderly patients represented 39% of the overall population (n=808: 221 patients in 2000; 587 in 2005). Elderly patients admitted in 2000 and 2005 had similar clinical characteristics. Compared with 2000, there was a significant increase in the use of aspirin, clopidogrel, reperfusion therapy (primary angioplasty), ACE inhibitors and statins in 2005. Conversely, the use of betablockers remained stable. At 1 month, we observed a huge and significant reduction in mortality between the 2 cohorts (7.2% in cohort 1 vs 4.9% in cohort 2, p=0.036). This difference was mainly due to a decrease in mortality among the elderly patients (17.2% in cohort 1 vs 8.5% in cohort 2, p<0.001). Adjustment on the propensity score did not significantly alter these results.
Conclusions: Between 2000 and 2005, a significant increase in the use of guidelines-recommended treatments was observed, associated with lower 30-day mortality. These data confirm that elderly patients benefit from increased use of guidelines-recommended therapy.