Post-Myocardial Infarction Risk Stratification
Post-Myocardial Infarction Risk Stratification
Background: The purpose of this study was to examine the use of post-myocardial infarction (MI) risk stratification in the elderly. Although expert panels have recommended risk stratification after MI, limited data are available on whether patients actually undergo suggested testing. In particular, concern has been raised that the elderly, who are at high risk for recurrent ischemia and short-term death, are not referred as often as younger patients for post-MI testing.
Methods: We studied the records of 192,311 Medicare patients (age >65 years) admitted with MI between January 1992 and November 1992. By combining Medicare part A and part B data, we created a longitudinal record of patient care within 60 days of an MI admission. We describe the pattern of post-MI testing for ischemia and left ventricular function and outcomes as a function of patient age.
Results: Patients >75 years of age were significantly less likely than patients 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 remained less likely than younger patients to have an assessment of coronary artery disease severity (odds ratio, 0.44) or left ventricular function (odds ratio, 0.65).
Conclusions: Post-MI risk stratification declines with age and falls short of recommendations in our nation's elderly. This lack of testing may result in lost opportunities for therapeutic interventions in this high-risk group.
Although only 60% of patients with myocardial infarction (MI) are older than 65 years of age, they account for >80% of MI-related deaths. Advancing age is associated with increased comorbidity and higher short-term mortality rates after MI, yet many of the oldest old can still benefit from aggressive care. Despite this, older patients receive fewer medications (eg, ß-blockers and aspirin) and fewer therapeutic interventions (eg, angioplasty and bypass surgery) after MI. The greater disease severity and higher rates of subsequent cardiac events in this population make risk stratification a useful strategy to select those elderly patients for whom additional treatments are likely to be helpful.
National guidelines suggest testing to assess ischemic risk and left ventricular (LV) function within several weeks after an acute MI (Table I). The guidelines emphasize that patients with greater disease severity and lower LV function have greater potential benefit from cardiovascular therapies including revascularization. Although prior work has shown a lower rate of cardiac catheterization after MI in the elderly, our study examines the use of any risk-stratification testing (cardiac catheterization, stress test, or echocardiography) within 60 days of MI.
Background: The purpose of this study was to examine the use of post-myocardial infarction (MI) risk stratification in the elderly. Although expert panels have recommended risk stratification after MI, limited data are available on whether patients actually undergo suggested testing. In particular, concern has been raised that the elderly, who are at high risk for recurrent ischemia and short-term death, are not referred as often as younger patients for post-MI testing.
Methods: We studied the records of 192,311 Medicare patients (age >65 years) admitted with MI between January 1992 and November 1992. By combining Medicare part A and part B data, we created a longitudinal record of patient care within 60 days of an MI admission. We describe the pattern of post-MI testing for ischemia and left ventricular function and outcomes as a function of patient age.
Results: Patients >75 years of age were significantly less likely than patients 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 remained less likely than younger patients to have an assessment of coronary artery disease severity (odds ratio, 0.44) or left ventricular function (odds ratio, 0.65).
Conclusions: Post-MI risk stratification declines with age and falls short of recommendations in our nation's elderly. This lack of testing may result in lost opportunities for therapeutic interventions in this high-risk group.
Although only 60% of patients with myocardial infarction (MI) are older than 65 years of age, they account for >80% of MI-related deaths. Advancing age is associated with increased comorbidity and higher short-term mortality rates after MI, yet many of the oldest old can still benefit from aggressive care. Despite this, older patients receive fewer medications (eg, ß-blockers and aspirin) and fewer therapeutic interventions (eg, angioplasty and bypass surgery) after MI. The greater disease severity and higher rates of subsequent cardiac events in this population make risk stratification a useful strategy to select those elderly patients for whom additional treatments are likely to be helpful.
National guidelines suggest testing to assess ischemic risk and left ventricular (LV) function within several weeks after an acute MI (Table I). The guidelines emphasize that patients with greater disease severity and lower LV function have greater potential benefit from cardiovascular therapies including revascularization. Although prior work has shown a lower rate of cardiac catheterization after MI in the elderly, our study examines the use of any risk-stratification testing (cardiac catheterization, stress test, or echocardiography) within 60 days of MI.
