Coronary Artery Diseases
Age-related trends in short- and long-term survival after acute myocardial infarction: a 20-year population-based perspective (1975–1995)

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Abstract

This study examines age-related differences and temporal trends in hospital and long-term survival after acute myocardial infarction (AMI) over a 2-decade-long (1975 to 1995) experience. A total of 8,070 patients with validated AMI hospitalized in all acute care hospitals in the Worcester, Massachusetts, metropolitan area (1990 census population 437,000) were studied over 10 one-year periods between 1975 and 1995. This population included 1,326 patients 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 years (23.3%), and 771 patients aged ≥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 74, 75 to 84, and ≥85 years were at 4.2, 7.8, and 10.2 times greater risk of dying, respectively. Similar age disparities in the risk of dying were seen when controlling for additional prognostic factors. 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. Among discharged hospital patients, increasing age was related to a significantly poorer long-term prognosis. Trends toward improving long-term prognosis were seen in patients discharged in the mid-1990s compared with those discharged in the mid- to late 1970s for patients aged <85 years. The present results demonstrate the marked impact of advancing age on survival after AMI. Despite the adverse impact of age on prognosis, encouraging trends in prognosis were observed in all age groups, although to a lesser extent in the oldest elderly patients. These findings emphasize the low death rates in middle-aged patients with AMI and the need for targeted secondary prevention efforts in elderly patients with AMI.

Section snippets

Methods

The population under study included residents of the Worcester, Massachusetts, metropolitan area hospitalized with a primary or secondary discharge diagnosis of AMI (International Classification of Disease Code 410) in all acute general hospitals in the Worcester standard metropolitan statistical area during 1975, 1978, 1981, 1984, 1986, 1988, 1990, 1991, 1993, and 1995.1, 2, 3 Sixteen hospitals were included in this study from the mid-1970s through the late 1980s, and fewer hospitals were

Age-related differences in demographic, clinical, and treatment characteristics

Elderly patients were significantly more likely to be women, to have selected comorbid conditions present, and more likely to experience a recurrent, non–Q-wave, anterior AMI, and a smaller infarct as reflected by peak creatine kinase findings (Table I). Elderly patients were significantly more likely to develop congestive heart failure and cardiogenic shock than were younger patients. The elderly were significantly less likely to be treated with each of the pharmacologic agents examined with

Discussion

The results of this multihospital, geographically defined study indicate the following: an adverse impact of increasing age on in-hospital and long-term survival for up to 10 years after AMI; improvements over a 2-decade span in hospital survival in all age groups under study, with the exception of the very elderly, after controlling for potentially confounding prognostic factors; and improvement over the period 1975/78 to 1993/95 in long-term survival rates within the initial 2 years after

Acknowledgements

The investigators are indebted to the cardiology, administration, and medical records departments at participating Worcester metropolitan area hospitals for making this project feasible.

References (27)

  • B.D Hoit et al.

    Myocardial infarction in young patientsan analysis by age subsets

    Circulation

    (1986)
  • A.P Maggioni et al.

    Age-related increase in mortality among patients with first myocardial infarctions treated with thrombolysis. The Investigators of the Gruppo Italiano per lo Studio della Sopravvienza nell’Infarto Miocardico (GISSI-2)

    N Engl J Med

    (1993)
  • J.H Gurwitz et al.

    Recent trends in hospital mortality of acute myocardial infarction—The Worcester Heart Attack Study. Have improvements been realized for all age groups?

    Arch Intern Med

    (1994)
  • Cited by (0)

    This study was supported by Grant R01 HL35434 from the National Institutes of Health, Bethesda, Maryland.

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