DIFFERENCES IN THE TREATMENT OF PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION ACCORDING TO PATIENT AGE

OBJECTIVE: To identify age-related differences in the treatment of pat ients with acute myocardial infarction. DESIGN: Retrospective cohort s tudy. SETTING: Two university-affiliate medical centers with integrate d clinical programs. PATIENTS: 329 patients admitted with acute myocar dial infarction in 1988-1990 for whom complete medical records were av ailable. Study exclusions included patients transferred from other hos pitals specifically to undergo angiography or other cardiac procedures , nursing home residents, patients with metastatic cancer or dementia, and patients in whom ''do not resuscitate'' orders were written durin g the first 2 hospital days. MEASUREMENTS: Medical records were review ed to determine socio-demographic data, comorbidity, admission severit y of illness, medications, the use of specific diagnostic and therapeu tic modalities during and after hospitalization, treatment limitations , and patient outcomes. MAIN RESULTS: Chronological age of patients wa s related to the use of several diagnostic and therapeutic modalities. Using logistic regression to adjust for comorbidity, severity, infarc t size and location, and other covariates, patients 75 years and older were 12 times less likely to receive thrombolytic therapy, 8 times le ss likely to undergo coronary angiography, and 7 times less likely to undergo coronary angioplasty than patients less than 65 years of age. However, age was not related to the use of other modalities, including echocardiography or gated blood pool scanning, pulmonary artery cathe terization, and transvenous pacing. Finally, in a logistic regression model, the risk of in-hospital death was 4 times greater for patients 75 years and older than patients less than 65 years. CONCLUSIONS: Phys icians' management of patients with acute myocardial infarction differ ed greatly according to patient age for some diagnostic and therapeuti c modalities, but not for others. These findings indicate that general izations about age-related practice variations should not be based on analysis of a single procedure. Moreover, judgments about the appropri ateness of age-related differences in management require knowledge of the relative effectiveness of management strategies in older and young er patients.