Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, 10833 LeConte Ave, Room 47-123 CHS, Los Angeles, CA 90095-1679, USA.
Circulation. 2010 Feb 23;121(7):879-91. doi: 10.1161/CIRCULATIONAHA.109.892497. Epub 2010 Feb 8.
Prior studies have suggested lower use of guideline-recommended therapy and worse poststroke outcomes in older patients. We sought to examine age-related differences in characteristics, performance measures, temporal trends, and early clinical outcomes for acute ischemic stroke in a large contemporary cohort.
The relationships between age and clinical characteristics, performance measures, and in-hospital outcomes were analyzed in 502 036 ischemic stroke admissions from 1256 hospitals in the Get With the Guidelines-Stroke program from 2003 to 2009. Data were analyzed by age groups (<50, 50 to 59, 60 to 69, 70 to 79, 80 to 89, and >/=90 years) and with age as a continuous variable. Seven predefined performance measures and 2 summary measures were analyzed. Mean age of ischemic stroke patients was 71.0+/-14.6 years; 52.5% were women. Older patients were more likely to have a history of atrial fibrillation or hypertension and less likely to be black, Hispanic, or current/recent smokers. Although modest age-related differences in each individual performance measure were identified, there were substantial temporal improvements in performance measures from 2003 to 2009 in each age group, and many age-related treatment gaps were narrowed or eliminated over time. Older patients were less likely to be discharged home (adjusted odds ratio, 0.69; 95% confidence interval, 0.68 to 0.69) and more likely to die in hospital (adjusted odds ratio, 1.27; 95% confidence interval, 1.25 to 1.29) for each 10-year age increase.
Older patients with ischemic stroke differ in clinical characteristics and experience higher in-hospital mortality than younger patients. Performance measure-based treatment rates improved substantially over time for ischemic stroke patients in all age groups, resulting in smaller age-related treatment gaps.
先前的研究表明，在老年患者中，指南推荐的治疗方法的使用率较低，卒中后结局较差。我们旨在研究在一个大型当代队列中，年龄相关的急性缺血性卒中的特征、表现测量、时间趋势和早期临床结局的差异。
在 2003 年至 2009 年期间，来自 Get With the Guidelines-Stroke 计划的 1256 家医院的 502036 例缺血性卒中患者中，分析了年龄与临床特征、表现测量和住院结局之间的关系。通过年龄组（<50 岁、50-59 岁、60-69 岁、70-79 岁、80-89 岁和>=90 岁）和年龄作为连续变量进行分析。分析了七个预先定义的表现测量和两个综合测量。缺血性卒中患者的平均年龄为 71.0+/-14.6 岁；52.5%为女性。老年患者更有可能有房颤或高血压病史，而不太可能是黑人、西班牙裔或当前/近期吸烟者。尽管在每个单独的表现测量中都发现了适度的年龄相关差异，但在每个年龄组中，从 2003 年到 2009 年，表现测量都有了实质性的提高，而且随着时间的推移，许多与年龄相关的治疗差距缩小或消除。对于每增加 10 岁，老年患者出院回家的可能性较小（调整后的优势比，0.69；95%置信区间，0.68 至 0.69），而在医院死亡的可能性较大（调整后的优势比，1.27；95%置信区间，1.25 至 1.29）。
与年轻患者相比，患有缺血性卒中的老年患者在临床特征上有所不同，住院死亡率更高。在所有年龄组的缺血性卒中患者中，基于表现测量的治疗率随着时间的推移显著提高，从而缩小了与年龄相关的治疗差距。
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