Montague T J, Wong R Y, Burton J R, Bay K S, Catellier D J, Teo K K
Epidemiology Coordinating and Research (EPICORE) Centre, University of Edmonton, Alberta.
Can J Cardiol. 1992 Jul-Aug;8(6):596-600.
To evaluate temporal changes in risk and patterns of hospital practice for acute myocardial infarction (AMI).
DESIGN/PATIENTS: Retrospective analysis of age-related medical therapy and outcome of 342 consecutive patients (132 at least 70 years old and 210 younger than 70) with AMI between July 1, 1989, and June 30, 1990, and comparison with data from two previous analyses of AMI practice in 1987 (n = 207) and 1988-89 (n = 402).
Tertiary care medical centre.
No direct interventions; results of the two previous AMI practice pattern analyses, however, were propagated during the practice time of the most recent analysis.
In 1989-90, hospital mortality was higher (19%) among patients at least 70 years old compared with patients younger than 70 (8%) (P less than 0.01). Therapies proven by repeated clinical trials to be effective in reducing AMI risk were all used less frequently in patients aged at least 70 years: thrombolysis (20 versus 43%); beta-blockers (41 versus 62%); acetylsalicylic acid (71 versus 87%); and nitrates (86 versus 97%). Qualitatively, these age-specific patterns of AMI mortality and therapy were similar to previous studies. Quantitatively, however, comparing 1987 with 1989-90 demonstrated parallel and marked increases in the use of all proven medications in both age groups, ranging from 42 to 230% (P less than 0.01). There was also a significant overall decrease in mortality from the 1987 patient cohort (20%) to the 1989-90 cohort (13%) (P less than 0.05). The decrease in mortality was entirely due to decreased mortality within the group 70 years or older; 35% in 1987 versus 19% in 1989-90 (P less than 0.05). Mortality in the AMI patients younger than 70 years old remained unchanged from 1987 to 1989-90.
Pattern of practice analyses were associated with, and may have contributed to, improved patient care and outcomes in AMI. Increased use of effective AMI medical therapy had a greater benefit in elderly higher risk AMI patients than lower risk younger patients. Persisting age-specific differences in AMI therapy may respond to more direct quality improvement measures, such as critical path management.
评估急性心肌梗死（AMI）医院治疗风险及模式的时间变化。
设计/患者：对1989年7月1日至1990年6月30日期间连续收治的342例AMI患者（132例年龄至少70岁，210例年龄小于70岁）进行年龄相关药物治疗及转归的回顾性分析，并与之前1987年（n = 207）和1988 - 1989年（n = 402）两次AMI治疗情况分析的数据进行比较。
三级医疗中心。
无直接干预措施；然而，前两次AMI治疗模式分析的结果在最近一次分析的治疗期间进行了推广。
1989 - 1990年，年龄至少70岁的患者医院死亡率（19%）高于年龄小于70岁的患者（8%）（P < 0.01）。经反复临床试验证明对降低AMI风险有效的治疗方法在年龄至少70岁的患者中使用频率均较低：溶栓治疗（20%对43%）；β受体阻滞剂（41%对62%）；乙酰水杨酸（71%对87%）；硝酸盐（86%对97%）。定性而言，这些特定年龄的AMI死亡率和治疗模式与之前的研究相似。但定量比较显示，1987年与1989 - 1990年，两个年龄组中所有已证实有效的药物使用量均呈平行且显著增加，增幅在42%至230%之间（P < 0.01）。从1987年患者队列（20%）到1989 - 1990年队列（13%），总体死亡率也有显著下降（P < 0.05）。死亡率的下降完全归因于70岁及以上组死亡率的降低；1987年为35%，1989 - 1990年为19%（P < 0.05）。1987年至1989 - 1990年，年龄小于70岁的AMI患者死亡率保持不变。
治疗模式分析与AMI患者护理及转归的改善相关，且可能起到了促进作用。有效AMI药物治疗的增加在老年高风险AMI患者中比低风险年轻患者带来更大益处。AMI治疗中持续存在的特定年龄差异可能需要更直接的质量改进措施来应对，如关键路径管理。
