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CLINICAL STUDY: MYOCARDIAL INFARCTION

Acute myocardial infarction in the elderly: differences by age

Rajendra H. Mehta, MD^*, Saif S. Rathore, MPH, Martha J. Radford, MD, FACC , Yongfei Wang, MS, Yun Wang, MS and Harlan M. Krumholz, MD, FACC ^||

^* Division of Cardiology, University of Michigan, Ann Arbor, Michigan, USA
Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut, USA
Qualidigm, Middletown, Connecticut, USA
^|| Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA

Manuscript received December 7, 2000; revised manuscript received May 3, 2001, accepted May 21, 2001.

Reprint requests and correspondence: Dr. Harlan M. Krumholz, Yale University School of Medicine, 333 Cedar Street, P.O. Box 208025, New Haven, Connecticut 06520-8025

OBJECTIVES

We evaluated the clinical characteristics and outcomes of elderly patients hospitalized with acute myocardial infarction (AMI) to describe differences by age.

BACKGROUND

Elderly patients with AMI are perceived as a homogeneous population, though the extent by which clinical characteristics vary among elderly patients has not been well described.

METHODS

Data from 163,140 hospital admissions of Medicare beneficiaries age 65 years between 1994 and 1996 with AMI at U.S. hospitals were evaluated for differences in clinical characteristics and mortality across five age-based strata (in years): 65 to 69, 70 to 74, 75 to 79, 80 to 84 and 85.

RESULTS

Older age was associated with a greater proportion of patients with functional limitations, heart failure, prior coronary disease and renal insufficiency and a lower proportion of male and diabetic patients. Of note, the proportion of patients presenting with chest pain within 6 h of symptom onset, and with ST-segment elevation, was lower in each successive age group. Thirty-day mortality rates were higher in older age groups (65 to 69: 10.9%, 70 to 74: 14.1%, 75 to 79: 18.5%, 80 to 84: 23.2%, 85: 31.2%, p = 0.001 for trend). The effect of age persisted but was attenuated after adjustment for differences in patient characteristics; similar trends were observed for one-year mortality.

CONCLUSIONS

Our data indicate significant age-associated differences in clinical characteristics in elderly patients with AMI, which account for some of the age-associated differences in mortality. The practice of grouping older patients together as a single age group may obscure important age-associated differences.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CABG = coronary artery bypass graft   CCP = Cooperative Cardiovascular Project   PTCA = percutaneous transluminal coronary angioplasty

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