Abstract 4348: Quality of Acute Myocardial Infarction Care and Outcomes in 33,997 Patients Aged 80 Years or Older: Results From GWTG-CAD
Background: Prior studies have demonstrated that older patients with acute myocardial infarction (AMI), particularly those aged ≥80 years, are less likely to receive evidence-based therapies, yet it remains unclear whether these differences persist among centers participating in a national quality improvement program.
Methods: Using data from American Heart Association’s Get With The Guidelines-Coronary Artery Disease (GWTG-CAD), we examined care and in-hospital outcomes among AMI patients treated at 416 US centers from 2000 –2009. Evidence based medical-therapy, door-to-needle time (DTN), door-to-balloon time (DTB), other quality measures, and in-hospital mortality for AMI care were analyzed.
Results: A total of 156,677 patients were included in the study. From the study population, 21.7% (n=33,997) were aged ≥80 years, with 45.3% (N=70,907) 18 – 64 and 33.0% (N=51,773) 65–79. Older patients were more frequently female and had higher prevalence of co-morbidities compared to younger patients. Overall, compliance with AMI evidence-based medical treatment upon admission and discharge was high, but age related differences in care were seen for most measures (table⇓). After multivariable adjustment, the mortality of the aged ≥80 patients was substantially higher compared to the youngest cohort OR=3.4 (95% CI: 3.2–3.8).
Conclusions: GWTG-CAD data demonstrate that use of evidence-based therapies in older AMI patients is higher in centers participating in a national quality improvement program compared to prior studies, yet there remains gaps in care quality among those aged ≥80 years. This suggests there remain opportunities to further improve care and outcomes in older AMI patients.
This research has received full or partial funding support from the American Heart Association, National Center.