AGE-RELATED DIFFERENCES IN THE UTILIZATION OF THERAPIES POST ACUTE MYOCARDIAL-INFARCTION

OBJECTIVE: To describe the effect of age on the care of patients hospi talized with acute myocardial infarction (MI). DESIGN: Retrospective c hart review of all cases with a primary or secondary discharge diagnos is of acute MI. SETTING: Two large community hospitals in Milwaukee, W isconsin, from July 1, 1990 to June 30, 1991. PATIENTS: There were 771 charts reviewed, of which, 149 cases were aged 54 years or younger, 2 03 were 55 to 64 years, 224 were 65 to 74 years, and 195 were aged 75 years or older. MEASUREMENTS: Hospital charts were examined for use of diagnostic and therapeutic interventions, including medications and p rocedures, as well as length of stay and in-hospital mortality. RESULT S: Older patients were more likely to be female (18%, 20%, 38%, and 56 % for the four age groups, respectively, P < .001 chi-square for linea r trend), more likely to present with congestive heart failure (31%, 3 9%, 51%, and 72%, P < .001), and had a higher in-hospital mortality ra te (5%, 7%, 10%, and 18%, P < .001). Older patients had a longer lengt h of stay in the hospital. The use of cardiac catheterization in these post-MI patients was high and did not decrease until after age 75 (85 %, 88%, 88%, and 47%, P < .001). The percentage of patients receiving balloon angioplasty decreased with age (51%, 51%, 43%, and 20%, P < .0 01), whereas the percentage of patients receiving myocardial revascula rization did not significantly differ with age (15%, 22%, 25%, and 19% , P = .46). Aspirin was less likely to be prescribed to older patients at discharge (79%, 82%, 70%, and 62%, P < .001). CONCLUSION: A surpri singly high percentage of those older than age 65 received invasive te sts and interventions. This high utilization rate coexists with our co ntinued ignorance about the efficacy of these tests and interventions in older adults.