- 作者：Jennifer Tjia ; Jeroan Allison ; Jane S. Saczynski ; Mayra Tisminetzky ; Jane L. Givens ; Kate Lapane ; Darleen Lessard ; Robert J. Goldberg
- 关键词：Acute myocardial infarction ; Geriatrics ; Medication effects ; Post-discharge survival
- 刊名：The American Journal of Medicine
- 出版年：2013
- 出版时间：September, 2013
- 年：2013
- 卷：126
- 期：9
- 页码：798-804
- 全文大小：510 K
Background
There are limited data informing the optimal treatment strategy for acute myocardial infarction in the oldest old (aged ¡Ý85 years). The study aim was to examine whether decade-long increases in guideline-based cardiac medication use mediate declines in post-discharge mortality among oldest old patients hospitalized with acute myocardial infarction.Methods
The study sample included 1137 patients aged ¡Ý85 years hospitalized in 6 biennial periods between 1997 and 2007 for acute myocardial infarction at all 11 greater Worcester, Massachusetts, medical centers. We examined trends in 90-day survival after hospital discharge and guideline-based medication use (aspirin, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers, lipid-lowering agents) for acute myocardial infarction during hospitalization and at discharge. Sequential multivariable Cox regression models examined the relationship among guideline-based medication use, study year, and 90-day post-discharge survival rates.
Results
Patients hospitalized between 2003 and 2007 experienced higher 90-day survival rates than those?hospitalized between 1997 and 2001 (69.1 % vs 59.8 % , P < .05). Between 1997 and 2007, the average number of guideline-based medications prescribed at discharge increased significantly (1.8 to 2.9, P?< .001). The unadjusted hazard ratio for 90-day post-discharge mortality in 2003-2007 compared with 1997-2001 was 0.73 (95 % confidence interval, 0.60-0.89); after adjustment for patient characteristics and guideline-based cardiac medication use, this relationship was no longer significant (hazard ratio, 1.26; 95 % confidence interval, 1.00-1.58).
Conclusions
Between 1997 and 2007, 90-day survival improved among a population-based sample of patients aged ¡Ý85 years hospitalized for acute myocardial infarction. This encouraging trend was explained by increased use of guideline-based medications.