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

doi:10.1093/ageing/afv162

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

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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 language	English
Pages (from-to)	96-103
Number of pages	8
Journal	Age and Ageing
Volume	45
Issue number	1
Early online date	24 Nov 2015
DOIs	https://doi.org/10.1093/ageing/afv162
Publication status	Published - Jan 2016

Bibliographical note

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.

Keywords

acute coronary syndrome
older people
quality of health care
survival

Access to Document

10.1093/ageing/afv162Licence: Unspecified

Accepted Manuscript
This is a pre-copyedited, author-produced PDF of an article accepted for publication in Age and Ageing following peer review. The version of record Zaman, MJ, Fleetcroft, R, Bachmann, M, Sarev, T, Stirling, S, Clark, A & Myint, PK 2016, 'Association of increasing age with receipt of specialist care and long-term mortality in patients with non-ST elevation myocardial infarction' Age and Ageing, vol 45, no. 1, pp. 96-103. is available online at doi: 10.1093/ageing/afv162
Accepted author manuscript, 188 KBLicence: Unspecified

Cite this

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

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.",

keywords = "acute coronary syndrome, older people, quality of health care, survival ",

author = "Zaman, {M. Justin} and Robert Fleetcroft and Max Bachmann and Toomas Sarev and Susan Stirling and Allan Clark and Myint, {Phyo Kyaw}",

note = "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.",

year = "2016",

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doi = "10.1093/ageing/afv162",

language = "English",

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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

SN - 0002-0729

VL - 45

SP - 96

EP - 103

JO - Age and Ageing

JF - Age and Ageing

IS - 1

ER -

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

Abstract

Bibliographical note

Keywords

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Cite this