Quality of acute myocardial infarction care and outcomes in 33,997 patients aged 80 years or older: Findings from Get with the Guidelines-Coronary Artery Disease (GWTG-CAD)

Objectives: To determine the adherence to national guidelines and in-hospital mortality of older patients with acute myocardial infarction (AMI) using a national database. Background: Prior studies have demonstrated that older patients are less likely to receive evidence-based therapies. Methods: Using data from the GWTG-CAD, we examined care and in-hospital outcomes among AMI patients treated at 416 US centers from 2000 to 2009. Evidence-based medical therapy, other quality measures, and in-hospital post-AMI mortality were analyzed. Results: A total of 156,677 patients were included in the study; 21.7% (n = 33,997) were aged ≥80 years, 33.0% (n = 51,773) 65 to 79 years, and 45.3% (n = 70,907) 18 to 64 years. Older patients had higher prevalence of comorbidities compared to younger patients. Overall, compliance with evidence-based medical treatment upon admission and discharge was high, but age-related differences in care were seen for most measures. After multivariate adjustment, the mortality of the patients aged ≥80 years was substantially higher compared to the youngest cohort (adjusted OR 3.4, 95% CI 3.2-3.8, P <.0001). There were substantial improvements in AMI quality measures over time in each age group. Conclusions: Among AMI patients aged ≥80 years, the use of evidence-based therapies was high and significant improvements over time have been observed in a national quality improvement program. Nevertheless, there remain important age-related gaps in care and outcomes, suggesting opportunities exist to improve prognosis in this high-risk population.