Age-related trends in short- and long-term survival after acute myocardialinfarction: A 20-year population-based perspective (1975-1995)

This study examines age-related differences and temporal trends in hospital and long-term survival after acute myocardial infarction (AMI) over a 2-de cade-long (1975 to 1995) experience. A total of 8,070 patients with validat ed AMI hospitalized in all acute care hospitals in the Worcester, Massachus etts, metropolitan area [1990 census population 437,000) were studied over 10 one-year periods between 1975 and 1995. This population included 1,326 p atients aged <55 years (16.4%), 1,768 patients aged 55 to 64 years (21.9%, 2,325 patients aged 65 to 74 years (28.8%), 1,880 patients aged 75 to 84 ye ars (23.3%), and 771 patients aged greater than or equal to 85 years (9.6%) . Compared with patients <55 years, patients 55 to 64 years were 2.2 times more likely to die during hospitalization for AMI, whereas patients 65 to 7 4, 75 to 84, and greater than or equal to 85 years were at 4.2, 7.8, and 10 .2 times greater risk of dying, respectively. Similar age disparities in th e risk of dying were seen when controlling for additional prognostic factor s. Despite the adverse impact of increasing age on hospital survival after AMI, declining in-hospital death rates were seen in each of the age groups under study, with declining magnitude of these trends with advancing age. A mong discharged hospital patients, increasing age was related to a signific antly poorer long-term prognosis. Trends toward improving long-term prognos is were seen in patients discharged in the mid-1990s compared with those di scharged in the mid- to late 1970s for patients aged <85 years. The present results demonstrate the marked impact of advancing age on survival after A MI. Despite the adverse impact of age on prognosis, encouraging trends in p rognosis were observed in all age groups, although to a lesser extent in th e oldest elderly patients. These findings emphasize the tow death rates in middle-aged patients with AMI and the need for targeted secondary preventio n efforts in elderly patients with AMI. (C) 1998 by Excerpta Medico, Inc.