The association between older age and receipt of care and outcomes in patients with acute coronary syndromes

Zaman, Justin, Stirling, Susan, Shepstone, Lee, Ryding, Alasdair, Flather, Marcus, Bachmann, Max ORCID: https://orcid.org/0000-0003-1770-3506 and Myint, Phyo (2014) The association between older age and receipt of care and outcomes in patients with acute coronary syndromes. European Heart Journal, 35 (23). pp. 1551-1558. ISSN 0195-668X

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Abstract

Aims: Older people increasingly constitute a large proportion of the acute coronary syndrome (ACS) population. We examined the relationship of age with receipt of more intensive management and secondary prevention medicine. Then, the comparative association of intensive management (reperfusion/angiography) over a conservative strategy on time to death was investigated by age. Methods and results: Using data from 155 818 patients in the national registry for ACS in England and Wales [the Myocardial Ischaemia National Audit Project (MINAP)], we found that older patients were incrementally less likely to receive secondary prevention medicines and intensive management for both ST-elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI). In STEMI patients ≥85 years, 55% received reperfusion compared with 84% in those aged 18 to <65 [odds ratio 0.22 (95% CI 0.21, 0.24)]. Not receiving intensive management was associated with worse survival [mean follow-up 2.29 years (SD 1.42)] in all age groups (adjusted for sex, cardiovascular risk factors, co-morbidities, healthcare factors, and case severity), but there was an incremental reduction in survival benefit from intensive management with increasing age. In STEMI patients aged 18–64, 65–74, 75–84, and ≥85, adjusted hazard ratios (HRs) for all-cause mortality comparing conservative treatment to intensive management were 1.98 (1.78, 2.19), 1.65 (1.51, 1.80), 1.62 (1.52, 1.72), and 1.36 (1.27, 1.47), respectively. In NSTEMI patients, the respective HRs were 4.37 (4.00, 4.78), 3.76 (3.54, 3.99), 2.79 (2.67, 2.91), and 1.90 (1.77, 2.04). Conclusion: We found an incremental reduction in the use of evidence-based therapies with increasing age using a national ACS registry cohort. While survival benefit from more intensive management reduced with older age, better survival was associated with intensive management at all ages highlighting the requirement to improve standard of care in older patients with ACS.

Item Type:	Article
Additional Information:	This is a pre-copyedited, author-produced PDF of an article accepted for publication in European Heart Journal following peer review. The version of record M. Justin Zaman, Susan Stirling, Lee Shepstone, Alisdair Ryding, Marcus Flather, Max Bachmann, Phyo Kyaw Myint, 2014, 35 (23), 1551-1558 DOI: 10.1093/eurheartj/ehu039 is available online at: http://eurheartj.oxfordjournals.org/content/35/23/1551
Uncontrolled Keywords:	acute coronary syndrome,age,elderly,prognosis
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health Faculty of Medicine and Health Sciences > Research Groups > Norwich Clinical Trials Unit Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care Faculty of Medicine and Health Sciences > Research Groups > Public Health and Health Services Research (former - to 2023) Faculty of Medicine and Health Sciences > Research Groups > Cardiovascular and Metabolic Health Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Centres > Population Health
Depositing User:	Pure Connector
Date Deposited:	01 Apr 2014 12:08
Last Modified:	27 Oct 2023 01:18
URI:	https://ueaeprints.uea.ac.uk/id/eprint/48310
DOI:	10.1093/eurheartj/ehu039

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