Author |
Avezum, A.
![]() Makdisse, M. ![]() Spencer, F. ![]() Gore, J. M. ![]() Fox, KAA ![]() Montalescot, G. ![]() Eagle, K. A. ![]() White, K. ![]() Mehta, R. H. ![]() Knobel, E. ![]() Collet, J. P. ![]() GRACCE Investigators ![]() |
Institution | Dante Pazzanese Cardiol Inst Universidade Federal de São Paulo (UNIFESP) Univ Massachusetts Univ Edinburgh Hop La Pitie Salpetriere Univ Michigan Albert Einstein Hosp |
Abstract | Background Evidence-based cardiac therapies are underutilized in elderly patients. We assessed differences in practice patterns, comorbidities, and in-hospital event rates, by age and type of acute coronary syndrome (ACS).Methods We studied 24165 ACS patients in 102 hospitals in 14 countries stratified by age.Results Approximately two-thirds of patients were men, but this proportion decreased with age. in elderly patients ( greater than or equal to 65 years), history of angina, transient ischemic attack/stroke, myocardial infarction(MI), congestive heart failure, coronary artery bypass graft (CABG) surgery, hypertension or atrial fibrillation were more common, and delay in seeking medical attention and non-ST-segment elevation MI were significantly higher. Aspirin, beta-blockers, thrombolytic therapy, statins and glycoprotein Ilb/Illa inhibitors were prescribed less, while calcium antagonists and angiotensin-converting enzyme inhibitors were prescribed more often to elderly patients. Unfractionated heparin was prescribed more often in young patients, while low-molecular-weight heparins were similarly prescribed across all age groups. Coronary angiography and percutaneous intervention rates significantly decreased with age. the rate of CABG surgery was highest among patients aged 65-74 years (8.1 %) and 55-6A years (7.7%), but reduced in the youngest (4.7%) and oldest (2.7%) groups. Major bleeding rates were,2-3% among patients aged < 65 years, and > 6% in those : 85 years. Hospital-mortality rates, adjusted for baseline risk differences, increased with age (odds ratio: 15.7 in patients greater than or equal to 85 years compared with those < 45 years).Conclusions Many elderly ACS patients do not receive evidence-based therapies, highlighting the need for clinical trials targeted specifically at elderly cohorts, and quality-of-care programs that reinforce the use of such therapies among these individuals. |
Language | English |
Date | 2005-01-01 |
Published in | American Heart Journal. St Louis: Mosby, Inc, v. 149, n. 1, p. 67-73, 2005. |
ISSN | 0002-8703 (Sherpa/Romeo, impact factor) |
Publisher | Mosby, Inc |
Extent | 67-73 |
Origin |
|
Access rights | Closed access |
Type | Article |
Web of Science ID | WOS:000226387000010 |
URI | http://repositorio.unifesp.br/handle/11600/28073 |
File | Size | Format | View |
---|---|---|---|
There are no files associated with this item. |