TY - JOUR
T1 - Evidence-based therapies for myocardial infarction
T2 - Secular trends and determinants of practice in the community
AU - Perschbacher, James M.
AU - Reeder, Guy S.
AU - Jacobsen, Steven J.
AU - Weston, Susan A.
AU - Killian, Jill M.
AU - Slobodova, Adriana
AU - Roger, Véronique L.
N1 - Funding Information:
This study was supported in part by grants (AR30582 and RO1HL59205) from the Public Health Service and the National Institutes of Health. Dr Roger is an Established Investigator of the American Heart Association.
PY - 2004/8
Y1 - 2004/8
N2 - OBJECTIVES: To examine secular trends in the use of evidence-based therapies in a geographically defined cohort of patients with myocardial infarction (MI) and to test the hypotheses that baseline use is increasing and that disparities in use are diminishing. PATIENTS AND METHODS: All consecutively hospitalized patients who were dismissed from Olmsted County, Minnesota, hospitals between 1979 and 1998 with a diagnosis of MI were identified using standardized criteria (biomarkers, cardiac pain, and electrocardiography). The entire community medical record, available via the Rochester Epidemiology Project, was reviewed to ascertain baseline characteristics including comorbidity, presence of ST-segment elevation on electrocardiography, and treatment. Logistic regression models were used to examine the association of treatment with age and sex, independent of other baseline characteristics. RESULTS: Between 1979 and 1998, 2317 Incident MIs (patient mean ± SD age, 67±14 years; 43% women; 57% aged ge;65 years) occurred in Olmsted County. The use of all evidence-based therapies increased over time, primarily reflecting the introduction of these medications at the time of index MI. Between 1389 and 1398, age was not independently associated with use of aspirin or ACE Inhibitors. Disparities in use persisted for reperfusion therapy and β-blockers. Reperfushion therapy or revascularization was used less frequently in older persons, particularly in elderly women (P<.001). Use of β-blockers decreased 16% among persons aged 65 years or older, independent of measurable differences in baseline characteristics and MI severity (hazard ratio, 0.84; 95% confidence Interval, 0.74-0.93). CONCLUSIONS: The use of all evidence-based therapies for MI increased markedly over time; however, residual gaps in use were noted. Reperfusion therapy or revascularization is used less frequently in women and elderly persons, and β-blockers are used less frequently in elderly persons. These differences are not explained by measurable differences in baseline characteristics. Women and elderly persons represent an increasing proportion of patients with MIs in the community; therefore, these findings define therapeutic opportunities.
AB - OBJECTIVES: To examine secular trends in the use of evidence-based therapies in a geographically defined cohort of patients with myocardial infarction (MI) and to test the hypotheses that baseline use is increasing and that disparities in use are diminishing. PATIENTS AND METHODS: All consecutively hospitalized patients who were dismissed from Olmsted County, Minnesota, hospitals between 1979 and 1998 with a diagnosis of MI were identified using standardized criteria (biomarkers, cardiac pain, and electrocardiography). The entire community medical record, available via the Rochester Epidemiology Project, was reviewed to ascertain baseline characteristics including comorbidity, presence of ST-segment elevation on electrocardiography, and treatment. Logistic regression models were used to examine the association of treatment with age and sex, independent of other baseline characteristics. RESULTS: Between 1979 and 1998, 2317 Incident MIs (patient mean ± SD age, 67±14 years; 43% women; 57% aged ge;65 years) occurred in Olmsted County. The use of all evidence-based therapies increased over time, primarily reflecting the introduction of these medications at the time of index MI. Between 1389 and 1398, age was not independently associated with use of aspirin or ACE Inhibitors. Disparities in use persisted for reperfusion therapy and β-blockers. Reperfushion therapy or revascularization was used less frequently in older persons, particularly in elderly women (P<.001). Use of β-blockers decreased 16% among persons aged 65 years or older, independent of measurable differences in baseline characteristics and MI severity (hazard ratio, 0.84; 95% confidence Interval, 0.74-0.93). CONCLUSIONS: The use of all evidence-based therapies for MI increased markedly over time; however, residual gaps in use were noted. Reperfusion therapy or revascularization is used less frequently in women and elderly persons, and β-blockers are used less frequently in elderly persons. These differences are not explained by measurable differences in baseline characteristics. Women and elderly persons represent an increasing proportion of patients with MIs in the community; therefore, these findings define therapeutic opportunities.
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U2 - 10.4065/79.8.983
DO - 10.4065/79.8.983
M3 - Article
C2 - 15301324
AN - SCOPUS:3442893543
SN - 0025-6196
VL - 79
SP - 983
EP - 991
JO - Mayo Clinic proceedings
JF - Mayo Clinic proceedings
IS - 8
ER -