Age‐Related Differences in the Utilization of Therapies Post Acute Myocardial Infarction

Abstract

A surprisingly high percentage of those older than age 65 received invasive tests and interventions. This high utilization rate coexists with our continued ignorance about the efficacy of these tests and interventions in older adults.

Management and Outcome of Acute Myocardial Infarction in Older Patients in the Thrombolytic Era

“…In addition, there was evidence for the underutilization of aspirin in our older patients. This is in accordance with numerous studies reporting the underutilization of proven effective therapies, in particular aspirin and beta‐blockers 28–31 …”

Use of Aspirin, β-Blockers, and Lipid-Lowering Medications Before Recurrent Acute Myocardial Infarction

“…However, nonclinical factors such as age and sex also affected patterns of receipt of these medications. Patients who were older (Ն75 years) were significantly less likely to use any of the 3 medications, a finding consistent with previous studies that show underuse of ␤-blockers [20][21][22] and aspirin 17 in elderly patients at hospital discharge after AMI. Yet, the survival benefit from ␤-blocker 21,39 and aspirin 1 therapy in patients with established coronary heart disease appears to be at least as great for elderly as nonelderly patients.…”

“…Results of well-designed clinical trials have been shown to affect the prescription of cardiovascular medications by physicians. 28,33 However, results of several previous studies conducted in the 1990s found significant underuse of aspirin [17][18][19] and ␤-blockers 18,20-23 at hospital discharge after an initial AMI despite the demonstrated efficacy of these medications in published clinical trials. Undertreatment of hypercholesterolemia among patients with established coronary heart disease also has been previously described.…”

“…13 Based on this evidence, widely publicized guidelines strongly recommend the routine long-term use of aspirin and ␤-blockers 14,15 in patients who recently had an AMI and lipid-lowering medications in patients with elevated cholesterol levels following hospital discharge after AMI. 13,16 Despite the positive findings of studies examining the effectiveness of these therapies and the widespread dissemination of these practice guidelines, findings of several previous studies [17][18][19][20][21][22][23] suggest that these medications are underprescribed to patients at hospital discharge after an AMI. Results of previous studies also suggest that nonclinical factors such as age, 17,21 sex, 20 and type of medical insurance 20 may affect the likelihood of receiving these medications at hospital discharge after an AMI.…”

β-Blocker Underuse in Secondary Prevention of Myocardial Infarction

“…[24][25][26] At discharge, as many as 80% of post-MI patients should be treated with β-blockers. 9 However, an analysis of nationwide prescribing patterns following hospital discharges showed that less than 40% of MI patients received β-blockers for secondary prevention of recurrent MI.…”