How should age affect management of acute myocardial infarction ? A prospective cohort study.
Background About 75% of patients with acute myocardial infarction are older than 70 years, but patients in this age group are commonly treated less vigorously than younger patients.
This differential treatment may partly reflect clinicians'misconceptions about the outlook of such patients, and the importance of age in clinical decisions.
We examined how age does and should affect the management of patients and risk stratification in acute myocardial infarction.
Methods In this prospective cohort study, we recruited 1225 consecutive patients admitted with acute myocardial infarction to a district general hospital in east London.
The primary endpoint was death.
We used tabulation and regression methods to analyse the association between age group and clinical variables.
Findings Patients aged 70 years or older took a longer time to arrive in hospital and were less likely to receive thrombolysis or discharge bêta-blockers than patients younger than 60 years : odds ratio 0.63 (95% Cl 9.45-0.88) for thrombolysis and 0.25 (0.16-0.37) for bêta-blockade, adjusted for sex, diabetes, previous acute myocardial infarction, Q wave infarction, and left-ventricular failure.
Left-ventricular failure was the strongest independent predictor of death within 1 year of infarction with a hazard ratio of 4.76 (3.53-6.43), adjusted for age, sex, diabetes, and Q wave infarction. (...)
Mots-clés Pascal : Infarctus, Myocarde, Aigu, Traitement, Critère âge, Etude cohorte, Stratégie, Facteur risque, Arbre décision, Personne âgée, Homme, Grande Bretagne, Royaume Uni, Europe, Etude longitudinale, Appareil circulatoire pathologie, Cardiopathie coronaire, Myocarde pathologie, Chimiothérapie
Mots-clés Pascal anglais : Infarct, Myocardium, Acute, Treatment, Age criterion, Cohort study, Strategy, Risk factor, Decision tree, Elderly, Human, Great Britain, United Kingdom, Europe, Follow up study, Cardiovascular disease, Coronary heart disease, Myocardial disease, Chemotherapy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0192613
Code Inist : 002B12A05. Création : 16/11/1999.