Gale, CP, Cattle, BA, Woolston, A et al. (7 more authors) (2012) Resolving inequalities in care? Reduced mortality in the elderly after acute coronary syndromes. The Myocardial Ischaemia National Audit Project 2003-2010. European Heart Journal, 33 (5). 630 - 639. ISSN 0195-668X
Abstract
Aims: To examine age-dependent in-hospital mortality for hospitalization with acute coronary syndromes (ACS) in England and Wales. Methods and results: Mixed-effects regression analysis using data from 616 011 ACS events at 255 hospitals as recorded in the Myocardial Ischemia National Audit Project (MINAP) 2003-2010; 102 415 (16.7%) patients were aged <55 years and 72 721 (11.9%) >/=85 years. Patients >/=85 years with ST-elevation myocardial infarction (STEMI) were less likely to receive emergency reperfusion therapy than those <55 years (RR = 0.27, 95% CI: 0.25-0.28). Older patients had greater lengths of stay (P< 0.001) and higher in-hospital mortality (P< 0.001). For STEMI and non-ST-elevation myocardial infarction (NSTEMI), there were reductions in in-hospital mortality from 2003 to 2010 across all age groups including the very elderly. For STEMI >/= 85 years, in-hospital mortality reduced from 30.1% in 2003 to 19.4% in 2010 (RR = 0.54, 95% CI: 0.38-0.75, P< 0.001), and for NSTEMI >/= 85 years, from 31.5% in 2003 to 20.4% in 2010 (RR = 0.56, 95% CI: 0.42-0.73, P< 0.001). Findings were upheld after multi-level adjustment (base = 2003): male STEMI 2010 OR = 0.60, 95% CI: 0.48-0.75; female STEMI 2010 OR = 0.55, 95% CI: 0.42-0.71; male NSTEMI OR = 0.50, 95% CI: 0.42-0.60; female NSTEMI OR = 0.49, 95% CI: 0.40-0.59. Conclusion: For patients hospitalized with ACS in England and Wales, there have been substantial reductions in in-hospital mortality rates from 2003 to 2010 across all age groups. The temporal improvements in mortality were similar for sex and type of acute myocardial infarction. Age-dependent inequalities in the management of ACS were apparent
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | This is a pre-copyedited, author-produced PDF of an article accepted for publication in the European Heart Journal following peer review. The definitive publisher-authenticated version (Gale, CP, Cattle, BA, Woolston, A, Baxter, PD, West, TH, Simms, AD, Blaxill, J, Greenwood, DC, Fox, KA and West, RM (2012) Resolving inequalities in care? Reduced mortality in the elderly after acute coronary syndromes. The Myocardial Ischaemia National Audit Project 2003-2010. European Heart Journal, 33 (5). 630 - 639. ISSN 0195-668X) is available online at: http://dx.doi.org/10.1093/eurheartj/ehr381 |
Keywords: | Acute coronary syndrome; Acute coronary syndromes; acute myocardial infarction; Adjustment; Age; Aged; Analysis; Audiy; Care; Elderly; Emergencies; Emergency; England; England and Wales; Epidemiology; Female; Hospital; Hospitalization; Hospitals; In-hospital mortality; Ischemia; Length; Male; management; mortality; mortality rate; Mortality-rates; Myocardial Infarction; Myocardial Ischemia; Myccardial-infarction; Older; Older patients; Patient; Patients; Rates; Regression Analysis; Reperfusion; Reperfusion therapy; Sex; Stay; Syndrome; Therapy; Wales; STEMI; NSTEMI; MINAP; Quality of care |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Genetics, Health and Therapeutics (LIGHT) > Biostatistics (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Genetics, Health and Therapeutics (LIGHT) > Division of Epidemiology & Biostatistics (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 25 Feb 2014 11:06 |
Last Modified: | 15 Sep 2014 01:55 |
Published Version: | http://dx.doi.org/10.1093/eurheartj/ehr381 |
Status: | Published |
Publisher: | Oxford University Press |
Identification Number: | 10.1093/eurheartj/ehr381 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:77859 |