ASPIRIN IN THE TREATMENT OF ACUTE MYOCARDIAL-INFARCTION IN ELDERLY MEDICARE BENEFICIARIES - PATTERNS OF USE AND OUTCOMES

Background Although aspirin is an effective, inexpensive, and safe tre atment of acute myocardial infarction, the frequency of use of aspirin in actual medical practice is not known. Elderly patients, a group wi th low rates of utilization of effective therapies such as thrombolyti c therapy, also may be at risk of not receiving aspirin for acute myoc ardial infarction. To address this issue, we sought to determine the c urrent pattern of aspirin use and to assess its effectiveness in a lar ge, population-based sample of elderly patients hospitalized with acut e myocardial infarction. Methods and Results As part of the Cooperativ e Cardiovascular Project Pilot, a Health Care Financing Administration initiative to improve quality of care for Medicare beneficiaries, we abstracted hospital medical records of Medicare beneficiaries who were hospitalized in Alabama, Connecticut, Iowa, or Wisconsin from June 19 92 through February 1993. Among the 10 018 patients greater than or eq ual to 65 years old who had no absolute contraindications to aspirin, 6140 patients (61%) received aspirin within the first 2 days of hospit alization. Patients who were older, had more comorbidity presented wit hout chest pain, and had highrisk characteristics such as heart failur e and shock were less likely to receive aspirin. The use of aspirin wa s significantly associated with a lower mortality (OR, 0.78; 95% CI, 0 .70 to 0.89) after adjustment for potential confounders. Conclusions A bout one third of elderly patients with acute myocardial infarction wh o had no contraindications to aspirin therapy did not receive it withi n the first 2 days of hospitalization. The elderly patients with the h ighest risk of death were the least likely to receive aspirin. After a djustment for differences between the treatment groups, the use of asp irin was associated with 22% lower odds of 30-day mortality. The incre ased use of aspirin for patients with acute myocardial infarction is a n excellent opportunity to improve the delivery of care to elderly pat ients.