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Recent Age-Related Trends in the Use of Thrombolytic Therapy in Patients Who Have Had Acute Myocardial Infarction

Jerry H. Gurwitz, MD; Joel M. Gore, MD; Robert J. Goldberg, PhD; Michael Rubison, PhD; Nisha Chandra, MD; and William J. Rogers, MD
[+] Article and Author Information

From Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; University of Massachusetts Medical School, Worcester, Massachusetts; ClinTrials Research, Inc., Lexington, Kentucky; the Johns Hopkins Bayview Medical Center, Baltimore, Maryland; and the University of Alabama Medical Center, Birmingham, Alabama. *For the Participants in the National Registry of Myocardial Infarction Acknowledgments: The authors thank Jack Nyberg for technical assistance with the analyses and Kelley Baron for manuscript preparation. Grant Support: The National Registry of Myocardial Infarction is supported by Genentech, Inc., South San Francisco, California. Dr. Gurwitz is the recipient of a clinical investigator award (K08 AG00510) from the National Institute on Aging, Bethesda, Maryland. Requests for Reprints: Jerry H. Gurwitz, MD, Program for the Analysis of Clinical Strategies, Brigham and Women's Hospital, 221 Longwood Avenue, Suite 341, Boston, MA 02115. Current Author Addresses: Dr. Gurwitz: Program for the Analysis of Clinical Strategies, Brigham and Women's Hospital, 221 Longwood Avenue, Suite 341, Boston, MA 02115.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1996;124(3):283-291. doi:10.7326/0003-4819-124-3-199602010-00001
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Objective: To examine recent trends in the use of thrombolytic therapy in elderly patients who have had acute myocardial infarction and to determine whether failure to meet time-to-hospital presentation and electrocardiographic criteria might explain age-related differences in the use of thrombolytic therapy.

Design: A national registry of patients who have had acute myocardial infarction.

Setting: 1249 U.S. hospitals.

Patients: 350 755 patients who had an acute myocardial infarction from 1 July 1990 to 30 September 1994.

Measurements: Trends in the proportions of patients who received thrombolytic therapy were examined according to age and sex. The association between age and treatment with a thrombolytic agent was determined by crude and multivariable-adjusted analyses.

Results: Use of a thrombolytic agent was inversely related to patient age: Almost 51% of patients younger than age 55 years received a thrombolytic agent during hospitalization for acute myocardial infarction; this proportion decreased to 43.6% for patients aged 55 to 64 years, 33.0% for those aged 65 to 74 years, 19.0% for those aged 75 to 84 years, and 7.4% for those aged 85 years or older. However, relative increases in the use of thrombolytic therapy over time were greatest for patients in the oldest age groups. Between 1 July 1990 and 30 June 1991, 16.0% of patients aged 75 to 84 years received a thrombolytic agent compared with 21.4% between 1 June 1993 and 30 September 1994 (a 33.8% relative increase in use). Among persons aged 85 years or older, the proportion of treated patients increased from 5.3% to 9.1% over this same period (a 71.7% relative increase in use). Increases in thrombolytic use were most prominent for older women. After adjustment for sex, diagnosis by initial electrocardiogram, electrocardiogram-based infarction description, time from symptom onset to hospital presentation, and period of the acute myocardial infarction, the odds of receiving a thrombolytic agent were significantly reduced for patients in the older age groups compared with the odds for patients younger than age 55 years (for patients aged 75 to 84 years, the adjusted odds ratio was 0.27 [95% CI, 0.26 to 0.28]; for patients aged 85 years or older, the odds ratio was 0.09 [CI, 0.08 to 0.10]).

Conclusions: Although older patients who have had acute myocardial infarction less commonly receive a thrombolytic agent, use of thrombolytic therapy in this population is expanding. However, substantial differences across age groups persist in the likelihood of receiving treatment, even after adjustment for potentially confounding factors. Age-related differences in thrombolytic use may not be completely explained by the degree to which older patients do not meet conventional eligibility criteria for thrombolytic therapy.

*A complete listing of participating registry hospitals is available from ClinTrials, Inc., Lexington, KY 40504.

Figures

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Figure 1.
Top.Bottom.

The proportions of all patients in each age group who had acute myocardial infarction and came to the hospital within 6 hours of symptom onset. The proportions of all patients in each age group who had acute myocardial infarction and came to the hospital 6 or more hours after symptom onset. The percentages shown above the solid area of each bar represent the proportion of parents who received a thrombolytic agent.

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