Importance of age in prehospital and hospital mortality of heart attacks.

Abstract

Prehospital and hospital fatality rates were calculated for each 10-year age group of 2788 patients transported to hospital with heart attacks. The prehospital fatality rate rose progressively from 4 per cent in the youngest age group to 45 per cent in the oldest. There was no age-related difference between the groups in the interval between the onset of symptoms and the first call for help, and a similar proportion of each group summoned a general practitioner. Among those admitted to hospital there was a progressive rise with age in the proportion eventually found to have had a definite or probable myocardial infarction, and among such patients the hospital fatality rate rose from 8 per cent in the youngest group to 35 per cent in the oldest. There was a progressive rise with age in the symptoms and signs of, and treatment for, heart failure. Reported fatality rates from myocardial infarction can only be interpreted if the ages of the patients are known in detail.

Age-Related Differences in Presentation, Treatment and Outcome of Acute Myocardial Infarction

“…Our findings confirm previous reports on the effect of age on in-hospital mortality [1,2,[5][6][7][8], the proportion of females [ 1,5,7,8] and the prevalence of previous infarction [5] and atypical symptoms on admission [9], Com parison among studies of actual figures, how ever, has to be done with great caution as inclusion and exclusion criteria, and defini tions of the evaluated parameters, may vary from one study to another. Despite these limi tations, all data point to the conclusion that the in-hospital mortality in the elderly is still high and that the 33% mortality in our pa tients >75 years is by no means exceptional.…”

“…As those patients are obviously at risk for rein farction -which may be expected to have a higher than usual fatality rate -they will prob ably contribute to the persisting high mortali ty rate. To strengthen this hypothesis, we like to mention first that in our study the propor tion of patients with previous MI rose sharply to 67% in patients > 75 years, whereas anoth er study between 1973 and 1977 reported a percentage varying from 8 to 31 % without an age-related trend [1], Secondly, our data, like data from other studies, show that, irrespective of age, rein farction bears a worse prognosis than a first MI; we found mortality rates of 12% in pa tients without previous MI and 22% in pa tients with previous MI [2,5], Our second major point of interest was the way the results of clinical trials on MI care were applied in our institution and whether differences among age groups were present or not [6,10,11]. As a rule, data on pharmaco logical treatment do meet standards set by recent trials [12].…”

Preinfarction Blood Pressure and Smoking Are Determinants for a Fatal Outcome of Myocardial Infarction

“…Smoking, serum cholesterol levels, and blood pressure are the classic coronary risk factors, but so far no firm conclusion has been drawn as to their role for a fatal outcome in MI. 1,[8][9][10][11][12] Factors that are known to influence the case fatality rate are an advanced age, 1,3,[12][13][14][15] a previous infarct, 1,10,12,14 and diabetes mellitus. 10,[16][17][18] Some studies claim that women fare better 11,14,17,18 or worse 19,20 than men after a major heart attack, while others [21][22][23][24][25] found no independent effect of sex.…”

“…The case fatality rate varies greatly between populations 35 and in different studies, 2,7,12,36 depending heavily on diagnostic criteria, whether nonfatal and fatal cases were detected to the same degree, and notably on whether the study was community or hospital based. Since age 1,3,[12][13][14][15] and a previous MI or stroke 1,10,12,14 are major predictors, the case fatality rate will depend on the composition of the study population. The case fatality rate of 31% among men in our study was somewhat lower than the 36% case fatality rate in first events in the British Regional Heart Study.…”

In-Hospital Death from Ischaemic Heart Disease

“…The influence of the long transit distance should be taken into account in the planning of health care services within an area. Both the pre-hospital and hospital fatal ity rates of AMI patients rise progressively from the younger to the older age groups [34], A severe heart disease preceding the attack is one obvious reason for early complications. In this respect, however, our groups of early HF and late HF did not differ.…”