TEMPORAL CHANGES IN THE CARE AND OUTCOMES OF ELDERLY PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION, 1987 THROUGH 1990

Objective.-To investigate changes between 1987 and 1990 in the care an d outcomes associated with acute myocardial infarction (AMI) in elderl y patients. Design.-Retrospective cohort study using a longitudinal da tabase created from Medicare administrative files. Patients.-Cohorts c omprising a total of 856 847 AMI patients insured by Medicare between 1987 and 1990. Main Outcome Measures.-Annual rates of mortality at 30 days and 1 year following AMI, and the use of coronary angiography, co ronary artery bypass graft surgery, and percutaneous transluminal coro nary angioplasty during the first 90 days after a new AMI. Results.-Be tween 1987 and 1990, mortality rates decreased 10% overall from 26% to 23% at 30 days (P<.001) and from 40% to 36% at 1 year following AMI ( P<.001). Declines in mortality and adjusted risks of 1-year mortality were similar in men and women and in blacks and whites, but mortality declines were more evident in those younger than 85 years. Meanwhile, the proportion of elderly AMI patients having angiography within the f irst 90 days after their index admission increased from 24% to 33% (P< .001); proportions increased for both genders and all races. The propo rtion of patients undergoing revascularization procedures increased fr om 13% to 21 %; while rates of bypass surgery increased from 8% to 11% , rates of angioplasty doubled from 5% to 10% (all P<.001). Conclusion s.-Between 1987 and 1990, survival of elderly patients following AMI i mproved significantly. While changes in patient treatment may be respo nsible, the increased use of thrombolytic therapy appears to be only a partial explanation. Also, while the use of coronary angiography and revascularization procedures increased dramatically, the degree to whi ch it caused the improvement in survival could not be determined.