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Evolution in Cardiovascular Care for Elderly Patients With Non–ST-Segment Elevation Acute Coronary Syndromes

Results From the CRUSADE National Quality Improvement Initiative

Karen P. Alexander, MD^_*,_*, Matthew T. Roe, MD, MHS^_*, Anita Y. Chen, MS^_*, Barbara L. Lytle, MS^_*, Charles V. Pollack, Jr, MD, MA, Joanne M. Foody, MD, William E. Boden, MD, Sidney C. Smith, Jr, MD^||, W. Brian Gibler, MD^¶, E. Magnus Ohman, MD^||, Eric D. Peterson, MD, MPH^_* for the CRUSADE Investigators

^_* Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, North Carolina
Pennsylvania Hospital, Philadelphia, Pennsylvania
Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
Division of Cardiology, Hartford Hospital, Hartford, Connecticut
^|| Department of Cardiology, University of North Carolina, Chapel Hill, North Carolina
^¶ Department of Emergency Medicine, University of Cincinnati School of Medicine, Cincinnati, Ohio

View larger version (20K): [in a new window]   Figure 1 Contraindications to short-term therapies by age and drug type. Includes contraindications defined by clinical criteria or provider discretion that use of the agent was contraindicated in specific patients. Open bars = <65 years old; grey bars = 65 to 74 years old; ruled bars = 75 to 84 years old; black bars = 85 years old. GP = glycoprotein.

View larger version (21K): [in a new window]   Figure 2 (A) Short-term use of medications within the first 24 h of admission by age (among those with no contraindications). (B) Use of in-hospital diagnostic and invasive procedures by age. (C) In-hospital mortality by age. (D) Discharge use of medications by age (among those with no contraindications). ACE = angiotensin-converting enzyme; CABG = coronary artery bypass grafting; Cath = catheterization; GP = glycoprotein; PCI = percutaneous coronary intervention.

View larger version (18K): [in a new window]   Figure 3 Adjusted in-hospital mortality among older and younger patients undergoing an early invasive strategy by the number of guideline recommendations applied (cardiac catheterization, short-term aspirin, short-term beta-blocker, short-term heparin, and short-term glycoprotein IIb/IIIa inhibitors). Dashed line = 75 years old; solid line = <75 years old.