ASPIRIN FOR SECONDARY PREVENTION AFTER ACUTE MYOCARDIAL-INFARCTION INTHE ELDERLY - PRESCRIBED USE AND OUTCOMES

Objectives: To determine how often aspirin was prescribed as a dischar ge medication to eligible patients 65 years of age and older who were hospitalized with an acute myocardial infarction; to identify patient characteristics associated with the decision to use aspirin; and to ev aluate the association between prescription of aspirin at discharge an d 6-month survival. Design: Observational study. Setting: All 352 nong overnment, acute care hospitals in Alabama, Connecticut, Iowa, and Wis consin. Patients: 5490 consecutive Medicare beneficiaries who survived an acute myocardial infarction, were hospitalized between June 1992 a nd February 1993, and did not have a contraindication to aspirin. Meas urements: Medical charts were reviewed to obtain information on the pr escription of aspirin at discharge, contraindications, patient demogra phic characteristics, and clinical factors. Results: 4149 patients (76 %) were prescribed aspirin at hospital discharge. In a multivariable a nalysis, an increased prescribed use of aspirin at discharge was corre lated with several indicators of better overall health status (better left ventricular ejection fraction, absence of diabetes, shorter lengt h of hospital stay, higher albumin level, and discharge to the patient 's home). The prescribed use of aspirin at discharge was also associat ed with several specific patterns of care, including the use of cardia c procedures, p-blocker therapy at discharge, and aspirin during the h ospitalization. The prescribed use of aspirin at discharge was associa ted with a lower mortality rate 6 months after discharge compared with no prescribed aspirin (odds ratio, 0.77; 95% CI, 0.61 to 0.98), even after adjustment for baseline differences in demographic, clinical, an d treatment characteristics between the two groups. Conclusions: Aspir in was not prescribed at discharge to 24% of elderly patients who were hospitalized with an acute myocardial infarction and did not have a c ontraindication to aspirin. Several patient characteristics were assoc iated with a higher risk for not being prescribed aspirin. Increasing the prescription of aspirin for these patients may provide an excellen t opportunity to improve their care.