Resolving inequalities in care? Reduced mortality in the elderly after acute coronary syndromes. The Myocardial Ischaemia National Audit Project 2003–2010
Open accessAbstract
AIMS: To examine age-dependent in-hospital mortality for hospitalization with acute coronary syndromes (ACS) in England and Wales. METHODS AND RESULTS: Mixed-effects regression analysis using data from 616 011 ACS events at 255 hospitals as recorded in the Myocardial Ischemia National Audit Project (MINAP) 2003-2010; 102 415 (16.7%) patients were aged <55 years and 72 721 (11.9%) ≥85 years. Patients ≥85 years with ST-elevation myocardial infarction (STEMI) were less likely to receive emergency reperfusion therapy than those <55 years (RR = 0.27, 95% CI: 0.25-0.28). Older patients had greater lengths of stay (P< 0.001) and higher in-hospital mortality (P< 0.001). For STEMI and non-ST-elevation myocardial infarction (NSTEMI), there were reductions in in-hospital mortality from 2003 to 2010 across all age groups including the very elderly. For STEMI ≥ 85 years, in-hospital mortality reduced from 30.1% in 2003 to 19.4% in 2010 (RR = 0.54, 95% CI: 0.38-0.75, P< 0.001), and for NSTEMI ≥ 85 years, from 31.5% in 2003 to 20.4% in 2010 (RR = 0.56, 95% CI: 0.42-0.73, P< 0.001). Findings were upheld after multi-level adjustment (base = 2003): male STEMI 2010 OR = 0.60, 95% CI: 0.48-0.75; female STEMI 2010 OR = 0.55, 95% CI: 0.42-0.71; male NSTEMI OR = 0.50, 95% CI: 0.42-0.60; female NSTEMI OR = 0.49, 95% CI: 0.40-0.59. CONCLUSION: For patients hospitalized with ACS in England and Wales, there have been substantial reductions in in-hospital mortality rates from 2003 to 2010 across all age groups. The temporal improvements in mortality were similar for sex and type of acute myocardial infarction. Age-dependent inequalities in the management of ACS were apparent.
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Coronary care has improved for older adults, with improving prognosis after a first MI.
“Coronary care has also been improved for older adults, with improving prognosis after the first MI. 320”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [320]
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- Authors
- Gale, C. P., Cattle, B. A., Woolston, A., Baxter, P. D., West, T. H., Simms, A. D., Blaxill, J., Greenwood, D. C., Fox, K. A. A., & West, R. M.
- Affiliations
- York Hospital (GB)
- University of Leeds (GB)
- Leeds Teaching Hospitals NHS Trust (GB)
- University of Edinburgh (GB)
- Corresponding author
- Gale, C. P.
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-10-18
- Volume
- 33
- Issue
- 5
- Pages
- 630-639
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2158181085
- Cited by
- 199
- References
- 40
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 2 · 2023: 6 · 2022: 10 · 2021: 10 · 2020: 12 · 2019: 13 · 2018: 13 · 2017: 21 · 2016: 28 · 2015: 19 · 2014: 28 · 2013: 13 · 2012: 12
- FWCI
- 11.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Funders
- National Science Foundation
- National Institute for Health and Care Research (NIHR/CS/009/004)
- British Heart Foundation (PG/07/057/23215)
- National Institutes of Health
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- acute coronary syndrome, in-hospital mortality, very elderly patients, ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, length of hospital stay, Myocardial Ischaemia National Audit Project, sex differences in mortality
- MeSH terms
- Adult, Aged, Aged, 80 and over, England, Female, Humans, Length of Stay, Male, Medical Audit, Middle Aged, Myocardial Infarction, Retrospective Studies, Risk Factors, Wales, Angioplasty, Balloon, Coronary, Thrombolytic Therapy, Hospital Mortality, Age Distribution, Acute Coronary Syndrome, Healthcare Disparities
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