Abstract
Background and objectives: The myocardial infarction (MI) incidence rate, prognosis and hospitalisation rate in the population 65 and over are rarely studied. We sought to determine MI hospitalisation and incidence rates, and 28-day case-fatality, in the 65 year and older population, and to analyse whether their management and prognosis differed from that of younger patients. Methods: All residents in Gerona (Spain) older than 24 years with suspected fatal or non-fatal MI were investigated and included in a population registry. Results: MI mortality, incidence, and case-fatality dramatically increased with age after 64. Smoking, thrombolysis, antiplatelet and betablocker drug use, coronary angiograms, and coronary revascularisation decreased with age. The risk of death of patients between 75 and 84 years (OR: 4.15, 95% confidence interval, CI: 1.70–10.15) and between 85 and 94 years (OR: 4.68, 95% CI: 1.62–13.52) was higher than in the 34–64 years age group, independently of any patient characteristic. Conclusions: The magnitude of the impact of MI in the elderly at population and hospital levels is substantially higher than in those younger than 65 years of age. After this age patients receive less treatments and procedures than their younger counterparts.
References
United Nations Population Division: World Population Prospects the 2002 Revision Population Database. (Cited 2003 June 13). [1 screen]. Available in URL: http://esa.un.org/unpp/index.asp?panel=2
Instituto Nacional de estadística. Morbilidad hospitalaria por enfermedad isquémica del corazón por sexo. España 1977-1999. (Cited 2003 June 12). [2 screens]. Available in URL: http://193.146.50.130/cardiov/tabla1i. html
Tunstall-Pedoe H, Kuulasma K, Mähönen M, et al., for the WHO MONICA Project. Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-Year results from 37 WHO MONICA Project populations. Lancet 1999; 353: 1547-1557.
Mc Govern PG, Pankow JS, Sharar E, et al. Recent trends in acute coronary heart disease-mortality, morbidity, medical care, and risk factors. N Engl J Med 1996; 334: 884-890.
Gurwitz JH. Col NF, Avron J. The exclusion of the elderly and women from clinical trials in acute myocardial infarction. JAMA 1992; 268: 1417-1422.
Pérez G, Pena A, Sala J, Roset PN, et al., and the REGICOR Investigators. Acute myocardial infarction case fatality, incidence and mortality rates in a population registry in Gerona, Spain, 1990-1992. Int J Epidemiol 1998; 27: 599-604.
Chambless L, Keil U, Dobson A, et al., for the MONICA Project. Population versus clinical view of case fatality from acute coronary heart disease. Results form the WHO-MONICA Project 1985-1990: Circulation 1997; 96: 3849-3859.
Murray CL, López A. Alternative projections of mortality and disability by cause 1990-2020: Global burden of disease study. Lancet 1997; 349: 1498-1504.
Thieman DR, Coresh J, Oetgen WJ, et al. The association between hospital volume and survival after acute myocardial infarction in elderly patients. N Engl J Med 1999; 340: 1640-1648.
Bueno H, López-Palop R, Bermejo J, et al. In-hospital outcome of elderly patients with acute inferior myocardial infarction and right ventricular involvement. Circulation 1997; 96: 436-441.
Ridker PM, Hennekens CH. Age and thrombolytic therapy. Circulation 1996; 94: 1807-1808.
Roig E, Castaner A, Simmons B, et al. In-hospital mortality rates from acute myocardial infarction by race in us hospitals: Findings from the National Hospital discharge survey. Circulation 1987; 76: 280-288.
Volmink JA, Newton JM, Hicks RN, Sleight P, Fowler GH, Neil HAW. Coronary event and case fatality rates in an English population: Results of the Oxford myocardial infarction incidence study. Heart 1998; 80: 40-44.
Goldberg RJ, McCormick D, Gurwitz JH, Yarzebsky J, Lessard D, Gore J. Age-related trends in short-and long-term survival after acute myocardial infarction: A 20-year population-based perspective (1975-1995). Am J Cardiol 1998; 82: 1311-1317.
Rosengren A, Spetz CL, Köster M, Hammar N, Alfredsson L, Rosén M. Sex differences in survival after myocardial infarction. Eur Heart J 2001; 22: 314-322.
McLaughlin TJ, Soumerai SB, Willison DJ, et al. Adherence to national guidelines for drug treatment of suspected acute myocardial infarction: Evidence for undertreatment in women and the elderly. Arch Intern Med 1996; 156: 799-805.
Krumholz HM. Ischaemic heart disease in the elderly. Rev esp Cardiol 2001; 4: 819-826.
Thieman DR, Coresh J, Schulman SP, et al. Lack of benefit for intravenous thrombolysis in patients with myocardial infarction who are older than 75 years. Circulation 2000; 101: 2239-2246.
Masiá R, Pena A, Marrugat J, et al. and the REGICOR Investigators. High prevalence of cardiovascular risk factors in Gerona, Spain, a province with low myocardial infarction incidence. J Epidemiol Comm Health 1998; 52: 707-715.
Artaud-Wild SM, Connor SL, Sexton G, et al. Differences in coronary mortality can be explained by differences in cholesterol and saturated fat intakes in 40 countries but not in France and Finland. Circulation 1993; 88: 2771-2779.
Ayanian JZ, Braunwald E. Thrombolytic therapy for patients with myocardial infarction who are older than 75 years. Circulation 2000; 101: 2224-2226.
Bueno H, López-Palop R, Pérez-David E, et al. Combined effect of age and right ventricular involvement on acute inferior myocardial infarction prognosis. Circulation 1998; 98: 1714-1720.
Lesnefsky EJ, Lundergan CF, Hodgson J, et al. Increased left ventricular dysfunction in elderly patients despite successful thrombolysis: The GUSTO-I angiographic experience. Am Coll Cardiol 1996; 28: 331-337.
Kannel WB, Vokonas PS. Demographics of the prevalence, incidence, and management of coronary heart disease in the elderly and in women. Ann Epidemiol 1992; 2: 5-14.
Nadelmann J, Frishman WH, Ooi WL, et al. Prevalence, incidence and prognosis of recognised and unrecognised myocardial infarction in persons aged 75 years or older: The Bronx Aging Study. Am J Cardiol 1990; 66: 533-537.
Sigurdsson E, Thorgeirsson G, Sigvaldason H, et al. Unrecognised myocardial infarction: Epidemiology, clinical characteristics, and the prognostic role of angina pectoris. The Reykjavik Study. Ann Int Med 1995; 122: 96-102.
White HD, Barbash GI, Califf RM, et al. for the GUSTO investigators. Circulation 1996; 94: 1826-1833.
Guadagnoli E, Landrum MB, Peterson EA, Gahart MT, Ryan TJ, McNeil BJ. Appropriateness of coronary angiography after myocardial infarction among MEDICARE beneficiaries. Managed care versus fee for service. N Engl J Med 2000; 343: 1460-1466.
Laster SB, Rutherford BD, Giorgi LV, et al. Results of direct percutaneous transluminal coronary angioplasty in octogenarians. Am J Cardiol 1996; 77: 10-13.
Marrugat J, D'Agostino R, Sullivan L, et al. An adaptation of the Framingham coronary risk function to southern Europe Mediterranean areas. J Epidemiol Comm Health 2003; 57: 1-6.
Löwel H, Dobson A, Keil U, et al. Coronary heart disease case fatality in four countries. A community study. Circulation 1993; 88: 2524-2531.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Marrugat, J., Sala, J., Manresa, J.M. et al. Acute myocardial infarction population incidence and in-hospital management factors associated to 28-day case-fatality in the 65 year and older. Eur J Epidemiol 19, 231–237 (2004). https://doi.org/10.1023/B:EJEP.0000020446.57845.b0
Issue Date:
DOI: https://doi.org/10.1023/B:EJEP.0000020446.57845.b0