Older patients with acute myocardial infarction receive lower quality emergency department care

Abstract

Study objectives: Morbidity and mortality after acute myocardial infarction (AMI) are higher for elderly patients. Some investigators have suggested that the higher mortality for elderly patients may be related to lower use of effective therapies. The objective of this study is to assess age-related rates of aspirin, β-blockers, and reperfusion therapy use for emergency department (ED) patients with AMI with no contraindications to these therapies. Methods: This was a cohort study of 2,215 consecutive, enzyme-confirmed patients with AMI presenting to 1 of 5 community EDs in Colorado and California from July 2000 through June 2002. ED and inpatient records were abstracted to obtain information on the use of aspirin, β-blockers, and reperfusion therapy; on contraindications to these treatments; on patient characteristics; and on clinical factors. We classified AMI patients into 4 age groups: younger than 60 years, 60 to 69 years, 70 to 79 years, and 80 years and older. Hierarchical multivariable regression was used to evaluate the relationship between age and the receipt of aspirin, β-blockers, and reperfusion therapy in ideal candidates while adjusting for patient and hospital characteristics and inhospital clustering. Results: There were 507 patients younger than 59 years, 431 patients 60 to 69 years, 667 patients 70 to 79 years, and 610 patients older than 80 years. Older age was inversely associated with rates of use of aspirin (<60 years=88.9%, 60 to 69 years=82.8%, 70 to 79 years=78.0%, and >80 years=70.0%; <i>P</i><.001), β-blockers (<60 years=68.5%, 60 to 69 years=64.7%, 70 to 79 years=55.4%, and >80 years=43.6%; <i>P</i><.001), and reperfusion therapy (<60 years=78.7%, 60 to 69 years=76.4%, 70 to 79 years=73.8%, and >80 years=43.9%; <i>P</i><.001). Adjusting for differences in demographic, clinical, and hospital characteristics did not significantly alter these findings. Conclusion: In this study, older patients with AMI, particularly those 80 years and older, were less likely to receive effective therapies in the ED than younger patients. These differences in ED process of care may partly explain the differential outcomes experienced by older patients with AMI.