Association of increasing age with receipt of specialist care and long-term mortality in patients with non-ST elevation myocardial infarction

M. Justin Zaman, Robert Fleetcroft, Max Bachmann, Toomas Sarev, Susan Stirling, Allan Clark, Phyo Kyaw Myint

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: observational studies suggest that older patients are less likely to receive secondary prevention medicines following acute coronary syndrome (ACS).

OBJECTIVES: to examine the association of increasing age with receipt of specialist care and influence of specialist care on long-term mortality in patients with non-ST elevation myocardial infarction (NSTEMI).

DESIGN: a cohort study.

SETTING: National ACS registry of England and Wales.

SUBJECTS: a total of 85,183 patients admitted with NSTEMI between 2006 and 2010.

METHODS: logistic regression analyses to assess receipt of secondary prevention medicines (ACE inhibitor, β-blocker, statin, aspirin) by age group; multivariate Cox regression models to examine longitudinal effect of cardiologist care on all-cause mortality by age group.

RESULTS: mean age 72.0 years (SD 13.0 years), mean follow-up was 2.13 years. Older patients received less cardiologist care (70.2% of NSTEMI patients ≥85 years compared with 94.7% of patients <65) years and had more co-morbidity. Cardiologists prescribed more secondary prevention in all age groups than generalists, but this was mostly explained away by co-morbidity (receipt of statin crude OR 1.51 (1.27,1.80), fully adjusted OR 1.11 (0.92,1.33) in patients ≥85 years). Receiving cardiologist care compared with generalist care was associated with a decreased risk of death in all even after adjustment for co-morbidity, disease severity and secondary prevention; this benefit reduced incrementally with older age group (adjusted hazard ratio (HR) 0.58 (0.49,0.68) aged <65; 0.87 (0.82,0.92) aged ≥85).

CONCLUSION: older patients with NSTEMI were less likely to see a cardiologist, but reduced treatment by generalists was explained away by co-morbidity. Cardiologist care was associated with lower mortality in all age groups than a generalist, but this survival benefit was less pronounced in older patients.

Original languageEnglish
Pages (from-to)96-103
Number of pages8
JournalAge and Ageing
Volume45
Issue number1
Early online date24 Nov 2015
DOIs
Publication statusPublished - Jan 2016

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Long-Term Care
Mortality
Secondary Prevention
Age Groups
Morbidity
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Acute Coronary Syndrome
Non-ST Elevated Myocardial Infarction
Wales
Proportional Hazards Models
Angiotensin-Converting Enzyme Inhibitors
England
Aspirin
Observational Studies
Registries
Cardiologists
Cohort Studies
Logistic Models
Regression Analysis
Survival

Keywords

  • acute coronary syndrome
  • older people
  • quality of health care
  • survival

Cite this

Association of increasing age with receipt of specialist care and long-term mortality in patients with non-ST elevation myocardial infarction. / Zaman, M. Justin; Fleetcroft, Robert; Bachmann, Max; Sarev, Toomas; Stirling, Susan; Clark, Allan; Myint, Phyo Kyaw.

In: Age and Ageing, Vol. 45, No. 1, 01.2016, p. 96-103.

Research output: Contribution to journalArticle

Zaman, M. Justin ; Fleetcroft, Robert ; Bachmann, Max ; Sarev, Toomas ; Stirling, Susan ; Clark, Allan ; Myint, Phyo Kyaw. / Association of increasing age with receipt of specialist care and long-term mortality in patients with non-ST elevation myocardial infarction. In: Age and Ageing. 2016 ; Vol. 45, No. 1. pp. 96-103.
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T1 - Association of increasing age with receipt of specialist care and long-term mortality in patients with non-ST elevation myocardial infarction

AU - Zaman, M. Justin

AU - Fleetcroft, Robert

AU - Bachmann, Max

AU - Sarev, Toomas

AU - Stirling, Susan

AU - Clark, Allan

AU - Myint, Phyo Kyaw

N1 - Acknowledgements We thank our funder, The Sir Halley Stewart Trust, for the funding support and the MINAP Academic Steering Committee for their approval to conduct the project.

PY - 2016/1

Y1 - 2016/1

N2 - BACKGROUND: observational studies suggest that older patients are less likely to receive secondary prevention medicines following acute coronary syndrome (ACS).OBJECTIVES: to examine the association of increasing age with receipt of specialist care and influence of specialist care on long-term mortality in patients with non-ST elevation myocardial infarction (NSTEMI).DESIGN: a cohort study.SETTING: National ACS registry of England and Wales.SUBJECTS: a total of 85,183 patients admitted with NSTEMI between 2006 and 2010.METHODS: logistic regression analyses to assess receipt of secondary prevention medicines (ACE inhibitor, β-blocker, statin, aspirin) by age group; multivariate Cox regression models to examine longitudinal effect of cardiologist care on all-cause mortality by age group.RESULTS: mean age 72.0 years (SD 13.0 years), mean follow-up was 2.13 years. Older patients received less cardiologist care (70.2% of NSTEMI patients ≥85 years compared with 94.7% of patients <65) years and had more co-morbidity. Cardiologists prescribed more secondary prevention in all age groups than generalists, but this was mostly explained away by co-morbidity (receipt of statin crude OR 1.51 (1.27,1.80), fully adjusted OR 1.11 (0.92,1.33) in patients ≥85 years). Receiving cardiologist care compared with generalist care was associated with a decreased risk of death in all even after adjustment for co-morbidity, disease severity and secondary prevention; this benefit reduced incrementally with older age group (adjusted hazard ratio (HR) 0.58 (0.49,0.68) aged <65; 0.87 (0.82,0.92) aged ≥85).CONCLUSION: older patients with NSTEMI were less likely to see a cardiologist, but reduced treatment by generalists was explained away by co-morbidity. Cardiologist care was associated with lower mortality in all age groups than a generalist, but this survival benefit was less pronounced in older patients.

AB - BACKGROUND: observational studies suggest that older patients are less likely to receive secondary prevention medicines following acute coronary syndrome (ACS).OBJECTIVES: to examine the association of increasing age with receipt of specialist care and influence of specialist care on long-term mortality in patients with non-ST elevation myocardial infarction (NSTEMI).DESIGN: a cohort study.SETTING: National ACS registry of England and Wales.SUBJECTS: a total of 85,183 patients admitted with NSTEMI between 2006 and 2010.METHODS: logistic regression analyses to assess receipt of secondary prevention medicines (ACE inhibitor, β-blocker, statin, aspirin) by age group; multivariate Cox regression models to examine longitudinal effect of cardiologist care on all-cause mortality by age group.RESULTS: mean age 72.0 years (SD 13.0 years), mean follow-up was 2.13 years. Older patients received less cardiologist care (70.2% of NSTEMI patients ≥85 years compared with 94.7% of patients <65) years and had more co-morbidity. Cardiologists prescribed more secondary prevention in all age groups than generalists, but this was mostly explained away by co-morbidity (receipt of statin crude OR 1.51 (1.27,1.80), fully adjusted OR 1.11 (0.92,1.33) in patients ≥85 years). Receiving cardiologist care compared with generalist care was associated with a decreased risk of death in all even after adjustment for co-morbidity, disease severity and secondary prevention; this benefit reduced incrementally with older age group (adjusted hazard ratio (HR) 0.58 (0.49,0.68) aged <65; 0.87 (0.82,0.92) aged ≥85).CONCLUSION: older patients with NSTEMI were less likely to see a cardiologist, but reduced treatment by generalists was explained away by co-morbidity. Cardiologist care was associated with lower mortality in all age groups than a generalist, but this survival benefit was less pronounced in older patients.

KW - acute coronary syndrome

KW - older people

KW - quality of health care

KW - survival

U2 - 10.1093/ageing/afv162

DO - 10.1093/ageing/afv162

M3 - Article

C2 - 26601697

VL - 45

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JO - Age and Ageing

JF - Age and Ageing

SN - 0002-0729

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