Cumulative incidence of death and rehospitalization among the elderly in the first year after NSTEMI

Renato D. Lopes, Shahyar Gharacholou, Dajuanicia N. Holmes, Laine Thomas, Tracy Y. Wang, Matthew T. Roe, Eric D. Peterson, Karen P. Alexander

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background Age is associated with outcomes in non-ST-segment elevation myocardial infarction; however, less is known about rehospitalization or death among elderly survivors. We aimed to evaluate mortality and cause-specific rehospitalization rates in this growing population of older adults with ischemic heart disease. Methods We linked 36,711 patients aged ≥65 years who survived an index non-ST-segment elevation myocardial infarction from the CRUSADE registry to Medicare claims data for follow-up. One-year survival estimates were compared by age group - 65-79, 80-84, 85-89, and ≥90 years - and Cox models were used to analyze the association between age and 1-year mortality. Results Death at 1 year increased markedly with age (from 13.3% for 65-79 years to 45.5% for ≥90 years). In contrast, rehospitalization rates at 1 year were similar and high across ages (65-79 years, 52.7%; ≥90 years, 56.5%), with nearly as many noncardiovascular-related as cardiovascular-related rehospitalizations. At 1 year, nonagenarians had substantially higher rates of death with or without preceding rehospitalization and twice the adjusted mortality than the group aged 65-79 years. Conclusions Evolving care delivery models should consider the high mortality in older adults after a non-ST-segment elevation myocardial infarction. Contrary to expectations, rehospitalization rates do not rise substantially with advancing age, and rehospitalization is often for noncardiac diagnoses.

Original languageEnglish (US)
Pages (from-to)582-590
Number of pages9
JournalAmerican Journal of Medicine
Volume128
Issue number6
DOIs
StatePublished - Jan 1 2015

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Mortality
Incidence
Medicare
Proportional Hazards Models
Myocardial Ischemia
Survivors
Registries
Age Groups
Non-ST Elevated Myocardial Infarction
Survival
Population

Keywords

  • Coronary disease
  • Death
  • Long-term outcomes
  • Myocardial infarction
  • Non-ST-segment elevation myocardial infarction
  • Rehospitalization

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Cumulative incidence of death and rehospitalization among the elderly in the first year after NSTEMI. / Lopes, Renato D.; Gharacholou, Shahyar; Holmes, Dajuanicia N.; Thomas, Laine; Wang, Tracy Y.; Roe, Matthew T.; Peterson, Eric D.; Alexander, Karen P.

In: American Journal of Medicine, Vol. 128, No. 6, 01.01.2015, p. 582-590.

Research output: Contribution to journalArticle

Lopes, Renato D. ; Gharacholou, Shahyar ; Holmes, Dajuanicia N. ; Thomas, Laine ; Wang, Tracy Y. ; Roe, Matthew T. ; Peterson, Eric D. ; Alexander, Karen P. / Cumulative incidence of death and rehospitalization among the elderly in the first year after NSTEMI. In: American Journal of Medicine. 2015 ; Vol. 128, No. 6. pp. 582-590.
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abstract = "Background Age is associated with outcomes in non-ST-segment elevation myocardial infarction; however, less is known about rehospitalization or death among elderly survivors. We aimed to evaluate mortality and cause-specific rehospitalization rates in this growing population of older adults with ischemic heart disease. Methods We linked 36,711 patients aged ≥65 years who survived an index non-ST-segment elevation myocardial infarction from the CRUSADE registry to Medicare claims data for follow-up. One-year survival estimates were compared by age group - 65-79, 80-84, 85-89, and ≥90 years - and Cox models were used to analyze the association between age and 1-year mortality. Results Death at 1 year increased markedly with age (from 13.3{\%} for 65-79 years to 45.5{\%} for ≥90 years). In contrast, rehospitalization rates at 1 year were similar and high across ages (65-79 years, 52.7{\%}; ≥90 years, 56.5{\%}), with nearly as many noncardiovascular-related as cardiovascular-related rehospitalizations. At 1 year, nonagenarians had substantially higher rates of death with or without preceding rehospitalization and twice the adjusted mortality than the group aged 65-79 years. Conclusions Evolving care delivery models should consider the high mortality in older adults after a non-ST-segment elevation myocardial infarction. Contrary to expectations, rehospitalization rates do not rise substantially with advancing age, and rehospitalization is often for noncardiac diagnoses.",
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N2 - Background Age is associated with outcomes in non-ST-segment elevation myocardial infarction; however, less is known about rehospitalization or death among elderly survivors. We aimed to evaluate mortality and cause-specific rehospitalization rates in this growing population of older adults with ischemic heart disease. Methods We linked 36,711 patients aged ≥65 years who survived an index non-ST-segment elevation myocardial infarction from the CRUSADE registry to Medicare claims data for follow-up. One-year survival estimates were compared by age group - 65-79, 80-84, 85-89, and ≥90 years - and Cox models were used to analyze the association between age and 1-year mortality. Results Death at 1 year increased markedly with age (from 13.3% for 65-79 years to 45.5% for ≥90 years). In contrast, rehospitalization rates at 1 year were similar and high across ages (65-79 years, 52.7%; ≥90 years, 56.5%), with nearly as many noncardiovascular-related as cardiovascular-related rehospitalizations. At 1 year, nonagenarians had substantially higher rates of death with or without preceding rehospitalization and twice the adjusted mortality than the group aged 65-79 years. Conclusions Evolving care delivery models should consider the high mortality in older adults after a non-ST-segment elevation myocardial infarction. Contrary to expectations, rehospitalization rates do not rise substantially with advancing age, and rehospitalization is often for noncardiac diagnoses.

AB - Background Age is associated with outcomes in non-ST-segment elevation myocardial infarction; however, less is known about rehospitalization or death among elderly survivors. We aimed to evaluate mortality and cause-specific rehospitalization rates in this growing population of older adults with ischemic heart disease. Methods We linked 36,711 patients aged ≥65 years who survived an index non-ST-segment elevation myocardial infarction from the CRUSADE registry to Medicare claims data for follow-up. One-year survival estimates were compared by age group - 65-79, 80-84, 85-89, and ≥90 years - and Cox models were used to analyze the association between age and 1-year mortality. Results Death at 1 year increased markedly with age (from 13.3% for 65-79 years to 45.5% for ≥90 years). In contrast, rehospitalization rates at 1 year were similar and high across ages (65-79 years, 52.7%; ≥90 years, 56.5%), with nearly as many noncardiovascular-related as cardiovascular-related rehospitalizations. At 1 year, nonagenarians had substantially higher rates of death with or without preceding rehospitalization and twice the adjusted mortality than the group aged 65-79 years. Conclusions Evolving care delivery models should consider the high mortality in older adults after a non-ST-segment elevation myocardial infarction. Contrary to expectations, rehospitalization rates do not rise substantially with advancing age, and rehospitalization is often for noncardiac diagnoses.

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