Post-myocardial infarction risk stratification in elderly patients

Background The purpose of this study was to examine the use of post- myocar dial infarction (MI) risk stratification in the elderly. Although expert pa nels have recommended risk stratification after MI, limited data are availa ble on whether patients actually undergo suggested testing. In particular, concern has been raised that the elderly, who are at high risk for recurren t ischemia and short-term death, are not referred os often as younger patie nts for post-MI testing. Methods We studied the records of 192,311 Medicare patients (age greater th an or equal to 65 years) admitted with MI between January 1992 and November 1992. By combining Medicare part A and part B data, we created a longitudi nal record of patient care within 60 days of an MI admission. We describe t he pattern of post-MI testing for ischemia and left ventricular function an d outcomes as a function of patient age Results Patients 275 years of age were significantly less likely than patie nts 65 to 74 years of age to have either cardiac catheterization (17% vs 43 %) or any test for coronary artery disease severity (24% vs 53%). They were also less likely to have a test of left ventricular function (61% vs 76%). Even after adjustment for baseline characteristics, older patients remaine d less likely than younger patients to have on assessment of coronary arter y disease severity (odds ratio, 0.44) or left ventricular function (odds ra tio, 0.65), Conclusions Post-MI risk stratification declines with age and falls short o f recommendations in our nation's elderly. This lock of testing may result in lost opportunities For therapeutic interventions in this high-risk group .