International comparison of treatment and long-term outcomes for acutemyocardial infarction in the elderly:Minneapolis/St. Paul, MN, USA and Gö teborg, Sweden

Lindsay G. Smith, Johan Herlitz, Thomas Karlsson, Alan K Berger, Russell V Luepker

Research output: Contribution to journalArticlepeer-review

28 Scopus citations

Abstract

Aims International studies provide an opportunity to compare treatment approaches and outcomes. The present study compares elderly hospitalized acute myocardial infarction (AMI) patients in Minneapolis/St. Paul, USA (MSP) and GoNteborg, Sweden (GB). Methods and results A population-based sample of hospitalized AMI (ICD-9 410) patients aged .75 in MSP and GB in 2001.02 was abstracted by trained nurses. Mortality was ascertained from medical records and death certificates. Demographics, cardiovascular procedures, and prescription medications were compared using sex-specific generalized linear models. Adjusted hazard ratios (HR) were calculated with Cox regression. In MSP 839 (387 men, 452 women) and in GB 564 (275 men, 289 women) patients were identified. Age was similar (men: MSP 83+7, GB 82+5; women: MSP 84+6, GB 84±6) yet MSP patients had more previous cardiovascular comorbidities and procedures (PCI/CABG). Guideline- based medication use was high in both locations. MSP patients were significantly more likely to undergo PCI (men: MSP 33%, GB 7%; women: MSP 30%, GB 7%). Survival at 7.5 years was 27.8% among MSP patients (men: 26.6%, women: 28.8%) and 17.2% amongGBpatients (men: 17.5%, women: 17.0%). After adjustment for baseline characteristics and guideline-based therapies, survival was higher among MSP men [HR: 0.66, 95% confidence interval (CI): 0.50.0.88] and women (HR: 0.49, 95% CI: 0.36.0.67) compared with GB. Conclusion In MSP and GB, guideline-based therapy usewas high. However, PCI usewas markedly higher in MSP. Long-term survival was better among elderly men and women in MSP compared with GB possibly related to greater utilization of PCI.

Original languageEnglish (US)
Pages (from-to)3191-3197
Number of pages7
JournalEuropean heart journal
Volume34
Issue number41
DOIs
StatePublished - Nov 1 2013

Keywords

  • Acute myocardial infarction
  • Elderly
  • International comparison

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