TY - JOUR
T1 - International comparison of treatment and long-term outcomes for acutemyocardial infarction in the elderly:Minneapolis/St. Paul, MN, USA and Gö teborg, Sweden
AU - Smith, Lindsay G.
AU - Herlitz, Johan
AU - Karlsson, Thomas
AU - Berger, Alan K
AU - Luepker, Russell V
N1 - Funding Information:
This work was supported by National Institute of Health (R01 HL023727 to R.V.L. and A.K.B.; K08 HL083611 to A.K.B.; T32 HL07779 to L.G.S.).
PY - 2013/11/1
Y1 - 2013/11/1
N2 - Aims International studies provide an opportunity to compare treatment approaches and outcomes. The present study compares elderly hospitalized acute myocardial infarction (AMI) patients in Minneapolis/St. Paul, USA (MSP) and GoNteborg, Sweden (GB). Methods and results A population-based sample of hospitalized AMI (ICD-9 410) patients aged .75 in MSP and GB in 2001.02 was abstracted by trained nurses. Mortality was ascertained from medical records and death certificates. Demographics, cardiovascular procedures, and prescription medications were compared using sex-specific generalized linear models. Adjusted hazard ratios (HR) were calculated with Cox regression. In MSP 839 (387 men, 452 women) and in GB 564 (275 men, 289 women) patients were identified. Age was similar (men: MSP 83+7, GB 82+5; women: MSP 84+6, GB 84±6) yet MSP patients had more previous cardiovascular comorbidities and procedures (PCI/CABG). Guideline- based medication use was high in both locations. MSP patients were significantly more likely to undergo PCI (men: MSP 33%, GB 7%; women: MSP 30%, GB 7%). Survival at 7.5 years was 27.8% among MSP patients (men: 26.6%, women: 28.8%) and 17.2% amongGBpatients (men: 17.5%, women: 17.0%). After adjustment for baseline characteristics and guideline-based therapies, survival was higher among MSP men [HR: 0.66, 95% confidence interval (CI): 0.50.0.88] and women (HR: 0.49, 95% CI: 0.36.0.67) compared with GB. Conclusion In MSP and GB, guideline-based therapy usewas high. However, PCI usewas markedly higher in MSP. Long-term survival was better among elderly men and women in MSP compared with GB possibly related to greater utilization of PCI.
AB - Aims International studies provide an opportunity to compare treatment approaches and outcomes. The present study compares elderly hospitalized acute myocardial infarction (AMI) patients in Minneapolis/St. Paul, USA (MSP) and GoNteborg, Sweden (GB). Methods and results A population-based sample of hospitalized AMI (ICD-9 410) patients aged .75 in MSP and GB in 2001.02 was abstracted by trained nurses. Mortality was ascertained from medical records and death certificates. Demographics, cardiovascular procedures, and prescription medications were compared using sex-specific generalized linear models. Adjusted hazard ratios (HR) were calculated with Cox regression. In MSP 839 (387 men, 452 women) and in GB 564 (275 men, 289 women) patients were identified. Age was similar (men: MSP 83+7, GB 82+5; women: MSP 84+6, GB 84±6) yet MSP patients had more previous cardiovascular comorbidities and procedures (PCI/CABG). Guideline- based medication use was high in both locations. MSP patients were significantly more likely to undergo PCI (men: MSP 33%, GB 7%; women: MSP 30%, GB 7%). Survival at 7.5 years was 27.8% among MSP patients (men: 26.6%, women: 28.8%) and 17.2% amongGBpatients (men: 17.5%, women: 17.0%). After adjustment for baseline characteristics and guideline-based therapies, survival was higher among MSP men [HR: 0.66, 95% confidence interval (CI): 0.50.0.88] and women (HR: 0.49, 95% CI: 0.36.0.67) compared with GB. Conclusion In MSP and GB, guideline-based therapy usewas high. However, PCI usewas markedly higher in MSP. Long-term survival was better among elderly men and women in MSP compared with GB possibly related to greater utilization of PCI.
KW - Acute myocardial infarction
KW - Elderly
KW - International comparison
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U2 - 10.1093/eurheartj/eht196
DO - 10.1093/eurheartj/eht196
M3 - Article
C2 - 23801823
AN - SCOPUS:84890071103
SN - 0195-668X
VL - 34
SP - 3191
EP - 3197
JO - European heart journal
JF - European heart journal
IS - 41
ER -