Should Older Patients with Acute Myocardial Infarction Receive Thrombolytic Therapy?

Williamson, Brian D.; Muller, David W.M.; Topol, Eric J.

doi:10.2165/00002512-199202060-00002

Cited by 4 publications

(2 citation statements)

References 23 publications

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“…Caring for older patients with an acute myocardial infarction (MI) may prove difficult because these patients present with chest pain less frequently, 1–13 may have a delay in presenting for their care, 6,14–16 more likely to present with congestive heart failure, 1,5,6,10–13 and have a higher in‐hospital mortality rate 1–13,17–26 . it should be emphasized, however, that at least 50% of all myocardial infarctions occur in those over age 65 27 ; therefore, it is critical to have good information about this age group.…”

mentioning

confidence: 99%

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

Malone¹,

Sial

Battiola³

et al. 1995

J American Geriatrics Society

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mentioning

confidence: 99%

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

Malone¹,

Sial

Battiola³

et al. 1995

J American Geriatrics Society

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“…Despite earl ier reservations about adm in istering thrombol ytic drugs to patients above 70 years of age because of a possible higher incidencc of major bleeding or intracranial bleeding, many r cecnt trials have con fi rmed a possi ble grealer benefit of these agents in sav ing more lives with an acceptable incidence of complications (A IMS 1 988: G I SS I· I 1986;ISIS-2 1988;Wilcox et al 1988: Williamson et al 1992.…”

Section: Cost-effectiveness Of Thrombolytic Therapy In the Elderlymentioning

confidence: 99%

Pharmacoeconomic Aspects of Treatment of Acute Myocardial Infarction with Thrombolytic Agents

Woo

White

1993

PharmacoEconomics

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Thrombolytic therapy reduces early mortality, preserves left ventricular function and improves long term prognosis of acute myocardial infarction. However it is relatively expensive and increasing use will have considerable financial consequences. With competing demand for health resources, information on economic evaluation of this revolutionary therapeutic modality is much needed. Economic evaluation of thrombolytic therapy of acute myocardial infarction entails the assessment of all resources consumed (costs) directly and indirectly in relation to the administration of thrombolytic drugs, versus the beneficial effects (outcome) on health preservation of the patients. To save 1 year of life, the costs of thrombolytic therapy using intravenous streptokinase, alteplase (recombinant tissue plasminogen activator; rt-PA) or anistreplase (anisoylated plasminogen streptokinase activator complex) under standard restricted indication criteria, vary from 1000 pounds British sterling to 1700 pounds British sterling in the UK, SEK3090 to 9660 in Scandinavia and $US35 000 to 800 000 in the US, depending on time delay in starting treatment after pain onset, size of infarct, thrombolytic agents used, study methodology, lists of clinical events considered in cost counting and the discount rate. Cost-utility analyses revealed that the costs of thrombolytic treatment are similar to those of many other treatments for cardiac or other diseases, but methods for evaluating quality of life and utility require further refinement and validation. Economic assessments confirm that thrombolytic treatment of the elderly ( greater than 70 years) is as cost-effective as treatment of younger patients and that both early and late thrombolytic therapy (given 6 to 12 hours after infarction) are beneficial and cost-effective. There are major logistical problems with prehospital thrombolysis, which despite great initial enthusiasm, is unlikely to be cost-effective in saving lives unless savings in time are greater than 1 hour. Cost-effectiveness/utility value of one drug determined from one study cannot be directly compared with that found in other studies using different drugs. More direct prospective comparative trials will be needed in respect of relative benefits and costs with different agents and adjunctive therapies.

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Thrombolytic Therapy in the Elderly

1996

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Elderly patients have the highest absolute risk of death following an acute myocardial infarction (MI); 16.1% for those aged between 65 and 74 years, and 25.3% for those older than 75 years. Therefore, this age-group potentially may benefit most from the use of thrombolytic therapy. Cost-effectiveness analysis of streptokinase therapy has estimated that in patients aged 70 to 80 years, the cost per life-year saved is between $US21,200 and $US22,400 (1990 dollars) compared with placebo treatment. Additional mortality benefits have been shown for accelerated alteplase compared with streptokinase-treated patients (30-day mortality for alteplase and streptokinase was 6.3% and 7.3%, respectively; p = 0.001). A prospective cost-effectiveness study for all age groups concluded that the cost of an additional year of life saved with alteplase compared with streptokinase was $US32,678 (1993 dollars). This extra cost of alteplase treatment declined to $US13,410 and $US16,246 with patients older than 75 years with anterior and inferior MI, respectively. In patients aged 40 years or younger with an anterior or inferior MI, and for those aged up to 60 years with an inferior infarction, the accepted cost-effectiveness ratio of $US50,000 was exceeded. Alteplase appears to be a cost-effective therapy for the treatment of elderly patients with acute MI.

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Should Older Patients with Acute Myocardial Infarction Receive Thrombolytic Therapy?

Cited by 4 publications

References 23 publications

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

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

Pharmacoeconomic Aspects of Treatment of Acute Myocardial Infarction with Thrombolytic Agents

Thrombolytic Therapy in the Elderly

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