OBJECTIVES We evaluated the clinical characteristics and outcomes of elderl
y patients hospitalized with acute myocardial infarction (AMI) to describe
differences by age.
BACKGROUND Elderly patients with AMI are perceived as a homogeneous populat
ion, though the extent by which clinical characteristics vary among elderly
patients has not been well described.
METHODS Data from 163,140 hospital admissions of Medicare beneficiaries age
greater than or equal to 65 years between 1994 and 1996 with AMI at U.S. h
ospitals were evaluated for differences in clinical characteristics and mor
tality across five age-based strata (in years): 65 to 69, 70 to 74, 75 to 7
9, 80 to 84 and greater than or equal to 85.
RESULTS Older age was associated with a greater proportion of patients with
functional limitations, heart failure, prior coronary disease and renal in
sufficiency and a lower proportion of male and diabetic patients. Of note,
the proportion of patients presenting with chest pain within 6 h of symptom
onset, and with ST-segment elevation, was lower in each successive age gro
up. Thirty-day mortality rates were higher in older age groups (65 to 69: 1
0.9%, 70 to 74: 14.1%, 75 to 79: 18.5%, 80 to 84: 23.2%, greater than or eq
ual to 85: 31.2%, p = 0.001 for trend). The effect of age persisted but was
attenuated after adjustment for differences in patient characteristics; si
milar trends were observed for one-year mortality.
CONCLUSIONS Our data indicate significant age-associated differences in cli
nical characteristics in elderly patients with AMI, which account for some
of the age-associated differences in mortality. The practice of grouping ol
der patients together as a single age group may obscure important age-assoc
iated differences. (C) 2001 by the American College of Cardiology.