The risk of hospitalization for acute myocardial infarction among older adults

Background. The purpose of this study was to prospectively examine the risk of hospitalization for acute myocardial infarction (AMI) in a large,nation ally representative sample of very old men and women. Methods. We utilized secondary analysis of the Longitudinal Study of Aging. Baseline (1984) in-person interview data were linked to Medicare hospitali zation records for 1984-1991. Subjects were 6,071 noninstitutionalized adul ts 70 years old or older at baseline. Hospitalization for AMI was defined a s having primary discharge diagnoses containing ICD9-CM 410 codes. Multivar iable proportional hazards regression was used to evaluate the epidemiologi c risks for all persons, and separately for women, men, self-respondents, t hose with no previous AMIs, and those with no history of coronary heart dis ease. Results. Of the sample, 357 persons (5.9%; 172 women and 185 men) had at le ast one primary discharge diagnosis of AMI. Significant (p < .05) risk fact ors for being hospitalized with an AMI (adjusted hazards ratios in parenthe ses) from the pooled analysis were male gender(1.86), having no more than a grade school education (1.35), atherosclerosis (1.43), hypertension (1.29) , coronary heart disease (1.63), angina (1.60), previous AMI (1.52), diabet es (1.89), and four or more lower body limitations (1.43). The gender-speci fic analyses, however, revealed that hypertension, angina, diabetes, and lo wer body limitations were risk factors only for women, and that having no m ore than a grade school education was a risk factor only for men. Conclusion. Men, especially those with low education, women with diabetes, angina, hypertension, or lower body limitations, and either men or women wi th previous AMIs, coronary heart disease, or atherosclerosis have elevated risks for AMI resulting in hospitalization, and they should be considered f or evaluation and monitoring. Current protocols for therapeutic management should be adopted, and compliance should be encouraged.