Delayed Thrombolytic Treatment of Older Patients with Acute Myocardial Infarction
OBJECTIVE: To determine demographic and clinical factors associated with delayed thrombolysis in patients with acute myocardial infarction. DESIGN: A retrospective cohort. SETTING: 37 Minnesota hospitals during the time periods October 1992‐July 1993 and July 1995‐April 1996. PATIENTS: We reviewed t...
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| Veröffentlicht in: | Journal of the American Geriatrics Society (JAGS) 1999-10, Vol.47 (10), p.1222-1228 |
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| container_title | Journal of the American Geriatrics Society (JAGS) |
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| creator | McLaughlin, Thomas J. Gurwitz, Jerry H. Willison, Donald J. Gao, Xiaoming Soumerai, Stephen B. |
| description | OBJECTIVE: To determine demographic and clinical factors associated with delayed thrombolysis in patients with acute myocardial infarction.
DESIGN: A retrospective cohort.
SETTING: 37 Minnesota hospitals during the time periods October 1992‐July 1993 and July 1995‐April 1996.
PATIENTS: We reviewed the medical records of 776 older patients aged 65 or older hospitalized with an admission diagnosis of acute myocardial infarction, suspected acute myocardial infarction, or rule‐out acute myocardial infarction, who were treated with a thrombolytic agent.
MEASUREMENT: We used multivariate logistic regression models to examine the association between selected study characteristics and time between hospital presentation and administration of thrombolytic treatment. Early thrombolysis was defined as less than 60 minutes after hospital presentation and late thrombolysis as 60+ minutes.
RESULTS: Of 776 study patients, 57.5% (n = 446) received early thrombolysis. Of the remaining 330 patients receiving late treatment, 12.1% (n = 94) were thrombolyzed more than 2 hours after hospital presentation. After controlling for other factors, the odds of delayed thrombolysis among patients aged 75 or older were 1.48 compared with younger individuals (95% CI, 1.17‐1.88). The odds of delayed thrombolysis among patients with severe comorbidity were 1.46 (95% CI, 1.10— 1.94) compared with individuals without severe comorbidity. Predictors of early thrombolytic treatment included hospital arrival via emergency transport (ORdelay = 0.46; 95% CI, 0.34–0.63) and chest discomfort at admission (ORdelay = 0.40; 95% CI, 0.18–0.86).
CONCLUSIONS: The present study indicates that patients of advanced age and with severe comorbidity are more likely to experience delayed thrombolytic treatment after hospital presentation. These are the patients who suffer the highest morbidity from acute myocardial infarction and for whom expeditious treatment may enhance therapeutic benefit. |
| doi_str_mv | 10.1111/j.1532-5415.1999.tb05203.x |
| format | Article |
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DESIGN: A retrospective cohort.
SETTING: 37 Minnesota hospitals during the time periods October 1992‐July 1993 and July 1995‐April 1996.
PATIENTS: We reviewed the medical records of 776 older patients aged 65 or older hospitalized with an admission diagnosis of acute myocardial infarction, suspected acute myocardial infarction, or rule‐out acute myocardial infarction, who were treated with a thrombolytic agent.
MEASUREMENT: We used multivariate logistic regression models to examine the association between selected study characteristics and time between hospital presentation and administration of thrombolytic treatment. Early thrombolysis was defined as less than 60 minutes after hospital presentation and late thrombolysis as 60+ minutes.
RESULTS: Of 776 study patients, 57.5% (n = 446) received early thrombolysis. Of the remaining 330 patients receiving late treatment, 12.1% (n = 94) were thrombolyzed more than 2 hours after hospital presentation. After controlling for other factors, the odds of delayed thrombolysis among patients aged 75 or older were 1.48 compared with younger individuals (95% CI, 1.17‐1.88). The odds of delayed thrombolysis among patients with severe comorbidity were 1.46 (95% CI, 1.10— 1.94) compared with individuals without severe comorbidity. Predictors of early thrombolytic treatment included hospital arrival via emergency transport (ORdelay = 0.46; 95% CI, 0.34–0.63) and chest discomfort at admission (ORdelay = 0.40; 95% CI, 0.18–0.86).
CONCLUSIONS: The present study indicates that patients of advanced age and with severe comorbidity are more likely to experience delayed thrombolytic treatment after hospital presentation. These are the patients who suffer the highest morbidity from acute myocardial infarction and for whom expeditious treatment may enhance therapeutic benefit.</description><identifier>ISSN: 0002-8614</identifier><identifier>EISSN: 1532-5415</identifier><identifier>DOI: 10.1111/j.1532-5415.1999.tb05203.x</identifier><identifier>PMID: 10522956</identifier><identifier>CODEN: JAGSAF</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>acute myocardial infarction ; Aged ; Biological and medical sciences ; Blood. Blood coagulation. Reticuloendothelial system ; Cardiology. Vascular system ; Clinical outcomes ; Cohort Studies ; Comorbidity ; Coronary heart disease ; elderly ; Female ; Health care access ; Heart ; Heart attacks ; Humans ; Logistic Models ; Male ; Medical sciences ; Myocardial Infarction - drug therapy ; Older people ; Pharmacology. Drug treatments ; Practice Patterns, Physicians ; quality of care ; Retrospective Studies ; Risk Factors ; Thrombolytic Therapy ; Time Factors</subject><ispartof>Journal of the American Geriatrics Society (JAGS), 1999-10, Vol.47 (10), p.1222-1228</ispartof><rights>1999 The American Geriatrics Society</rights><rights>1999 INIST-CNRS</rights><rights>Copyright Lippincott Williams & Wilkins Oct 1999</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4653-7509f99c6f3fbcfc613cc53918c56ae0956ee0d6f05ac1881f0ab54189d9f97e3</citedby><cites>FETCH-LOGICAL-c4653-7509f99c6f3fbcfc613cc53918c56ae0956ee0d6f05ac1881f0ab54189d9f97e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1532-5415.1999.tb05203.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1532-5415.1999.tb05203.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1992325$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10522956$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McLaughlin, Thomas J.</creatorcontrib><creatorcontrib>Gurwitz, Jerry H.</creatorcontrib><creatorcontrib>Willison, Donald J.</creatorcontrib><creatorcontrib>Gao, Xiaoming</creatorcontrib><creatorcontrib>Soumerai, Stephen B.</creatorcontrib><title>Delayed Thrombolytic Treatment of Older Patients with Acute Myocardial Infarction</title><title>Journal of the American Geriatrics Society (JAGS)</title><addtitle>J Am Geriatr Soc</addtitle><description>OBJECTIVE: To determine demographic and clinical factors associated with delayed thrombolysis in patients with acute myocardial infarction.
DESIGN: A retrospective cohort.
SETTING: 37 Minnesota hospitals during the time periods October 1992‐July 1993 and July 1995‐April 1996.
PATIENTS: We reviewed the medical records of 776 older patients aged 65 or older hospitalized with an admission diagnosis of acute myocardial infarction, suspected acute myocardial infarction, or rule‐out acute myocardial infarction, who were treated with a thrombolytic agent.
MEASUREMENT: We used multivariate logistic regression models to examine the association between selected study characteristics and time between hospital presentation and administration of thrombolytic treatment. Early thrombolysis was defined as less than 60 minutes after hospital presentation and late thrombolysis as 60+ minutes.
RESULTS: Of 776 study patients, 57.5% (n = 446) received early thrombolysis. Of the remaining 330 patients receiving late treatment, 12.1% (n = 94) were thrombolyzed more than 2 hours after hospital presentation. After controlling for other factors, the odds of delayed thrombolysis among patients aged 75 or older were 1.48 compared with younger individuals (95% CI, 1.17‐1.88). The odds of delayed thrombolysis among patients with severe comorbidity were 1.46 (95% CI, 1.10— 1.94) compared with individuals without severe comorbidity. Predictors of early thrombolytic treatment included hospital arrival via emergency transport (ORdelay = 0.46; 95% CI, 0.34–0.63) and chest discomfort at admission (ORdelay = 0.40; 95% CI, 0.18–0.86).
CONCLUSIONS: The present study indicates that patients of advanced age and with severe comorbidity are more likely to experience delayed thrombolytic treatment after hospital presentation. These are the patients who suffer the highest morbidity from acute myocardial infarction and for whom expeditious treatment may enhance therapeutic benefit.</description><subject>acute myocardial infarction</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Blood. Blood coagulation. Reticuloendothelial system</subject><subject>Cardiology. Vascular system</subject><subject>Clinical outcomes</subject><subject>Cohort Studies</subject><subject>Comorbidity</subject><subject>Coronary heart disease</subject><subject>elderly</subject><subject>Female</subject><subject>Health care access</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Myocardial Infarction - drug therapy</subject><subject>Older people</subject><subject>Pharmacology. Drug treatments</subject><subject>Practice Patterns, Physicians</subject><subject>quality of care</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Thrombolytic Therapy</subject><subject>Time Factors</subject><issn>0002-8614</issn><issn>1532-5415</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqVkNFv1CAcx4lxcefmv2CaxfjWCuWg4ItZTu_cMt2WnTHxhVAKGWdbJtDs-t9L08s0vskLBD7f7-_LF4AzBAuU1rtdgQguc7JEpECc8yLWkJQQF_tnYPH09BwsIIRlzihaHoOXIewgRCVk7AU4RokvOaELcPtRt3LUTba9966rXTtGq7Kt1zJ2uo-ZM9l122if3cho00XIHm28z87VEHX2ZXRK-sbKNrvojfQqWtefgiMj26BfHfYT8G39abv6nF9dby5W51e5WlKC84pAbjhX1GBTK6MowkoRzBFThEoNUzqtYUMNJFIhxpCBsk7_YrxJukrjE_B29n3w7tegQxSdDUq3rey1G4KoIFtSxnACz_4Bd27wfcomSgRxRUs8Qe9nSHkXgtdGPHjbST8KBMXUutiJqVoxVSum1sWhdbFP4teHCUPd6eYv6VxzAt4cABmUbI2XvbLhD8d5iUuSsA8z9mhbPf5HAnG5uZtOySGfHWyIev_kIP1PQStcEfH960ZUP1Z3a77eiFv8G2TfrZo</recordid><startdate>199910</startdate><enddate>199910</enddate><creator>McLaughlin, Thomas J.</creator><creator>Gurwitz, Jerry H.</creator><creator>Willison, Donald J.</creator><creator>Gao, Xiaoming</creator><creator>Soumerai, Stephen B.</creator><general>Blackwell Publishing Ltd</general><general>Blackwell</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>199910</creationdate><title>Delayed Thrombolytic Treatment of Older Patients with Acute Myocardial Infarction</title><author>McLaughlin, Thomas J. ; Gurwitz, Jerry H. ; Willison, Donald J. ; Gao, Xiaoming ; Soumerai, Stephen B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4653-7509f99c6f3fbcfc613cc53918c56ae0956ee0d6f05ac1881f0ab54189d9f97e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>acute myocardial infarction</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Blood. Blood coagulation. Reticuloendothelial system</topic><topic>Cardiology. Vascular system</topic><topic>Clinical outcomes</topic><topic>Cohort Studies</topic><topic>Comorbidity</topic><topic>Coronary heart disease</topic><topic>elderly</topic><topic>Female</topic><topic>Health care access</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Myocardial Infarction - drug therapy</topic><topic>Older people</topic><topic>Pharmacology. Drug treatments</topic><topic>Practice Patterns, Physicians</topic><topic>quality of care</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Thrombolytic Therapy</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McLaughlin, Thomas J.</creatorcontrib><creatorcontrib>Gurwitz, Jerry H.</creatorcontrib><creatorcontrib>Willison, Donald J.</creatorcontrib><creatorcontrib>Gao, Xiaoming</creatorcontrib><creatorcontrib>Soumerai, Stephen B.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McLaughlin, Thomas J.</au><au>Gurwitz, Jerry H.</au><au>Willison, Donald J.</au><au>Gao, Xiaoming</au><au>Soumerai, Stephen B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Delayed Thrombolytic Treatment of Older Patients with Acute Myocardial Infarction</atitle><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle><addtitle>J Am Geriatr Soc</addtitle><date>1999-10</date><risdate>1999</risdate><volume>47</volume><issue>10</issue><spage>1222</spage><epage>1228</epage><pages>1222-1228</pages><issn>0002-8614</issn><eissn>1532-5415</eissn><coden>JAGSAF</coden><abstract>OBJECTIVE: To determine demographic and clinical factors associated with delayed thrombolysis in patients with acute myocardial infarction.
DESIGN: A retrospective cohort.
SETTING: 37 Minnesota hospitals during the time periods October 1992‐July 1993 and July 1995‐April 1996.
PATIENTS: We reviewed the medical records of 776 older patients aged 65 or older hospitalized with an admission diagnosis of acute myocardial infarction, suspected acute myocardial infarction, or rule‐out acute myocardial infarction, who were treated with a thrombolytic agent.
MEASUREMENT: We used multivariate logistic regression models to examine the association between selected study characteristics and time between hospital presentation and administration of thrombolytic treatment. Early thrombolysis was defined as less than 60 minutes after hospital presentation and late thrombolysis as 60+ minutes.
RESULTS: Of 776 study patients, 57.5% (n = 446) received early thrombolysis. Of the remaining 330 patients receiving late treatment, 12.1% (n = 94) were thrombolyzed more than 2 hours after hospital presentation. After controlling for other factors, the odds of delayed thrombolysis among patients aged 75 or older were 1.48 compared with younger individuals (95% CI, 1.17‐1.88). The odds of delayed thrombolysis among patients with severe comorbidity were 1.46 (95% CI, 1.10— 1.94) compared with individuals without severe comorbidity. Predictors of early thrombolytic treatment included hospital arrival via emergency transport (ORdelay = 0.46; 95% CI, 0.34–0.63) and chest discomfort at admission (ORdelay = 0.40; 95% CI, 0.18–0.86).
CONCLUSIONS: The present study indicates that patients of advanced age and with severe comorbidity are more likely to experience delayed thrombolytic treatment after hospital presentation. These are the patients who suffer the highest morbidity from acute myocardial infarction and for whom expeditious treatment may enhance therapeutic benefit.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>10522956</pmid><doi>10.1111/j.1532-5415.1999.tb05203.x</doi><tpages>7</tpages></addata></record> |
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| issn | 0002-8614 1532-5415 |
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| source | Wiley-Blackwell Journals; MEDLINE |
| subjects | acute myocardial infarction Aged Biological and medical sciences Blood. Blood coagulation. Reticuloendothelial system Cardiology. Vascular system Clinical outcomes Cohort Studies Comorbidity Coronary heart disease elderly Female Health care access Heart Heart attacks Humans Logistic Models Male Medical sciences Myocardial Infarction - drug therapy Older people Pharmacology. Drug treatments Practice Patterns, Physicians quality of care Retrospective Studies Risk Factors Thrombolytic Therapy Time Factors |
| title | Delayed Thrombolytic Treatment of Older Patients with Acute Myocardial Infarction |
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