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Relationship between care gaps and projected life expectancy after acute myocardial infarction.
- Source :
-
Circulation. Cardiovascular quality and outcomes [Circ Cardiovasc Qual Outcomes] 2014 Jul; Vol. 7 (4), pp. 581-8. Date of Electronic Publication: 2014 Jun 03. - Publication Year :
- 2014
-
Abstract
- Background: Higher-risk patients may not receive evidence-based therapy because of limited life expectancy, which is a composite measure that encompasses many patient factors, including age, frailty, and comorbidities. In this study, we evaluated the extent to which treatment care gaps can be explained by a difference in projected life expectancy.<br />Methods and Results: An observational cohort study was conducted on acute myocardial infarction patients hospitalized in Ontario, Canada. Projected life expectancy was estimated using actual survival data with extrapolation using proportional hazard models adjusting for important covariates. The relationship between projected life expectancy with statins and reperfusion therapy was examined using generalized linear models. Among the 7001 acute myocardial infarction patients, 84.3% were prescribed statins and 72.9% were treated with reperfusion therapy. When projected life expectancy was <10 years, the likelihood of receiving either treatment declined progressively with reduction in life expectancy (P<0.001). At the 25th percentile of projected life expectancies, the likelihood of receiving a statin decreased by 1.4% (95% confidence interval, 1.0-1.8%), and acute reperfusion therapy decreased by 2.6% (95% confidence interval, 1.8-3.3%) for each year decline in projected life expectancy.<br />Conclusions: Life expectancy of a patient strongly influences evidence-based treatment in acute myocardial infarction. It was seen not only among patients with limited life expectancies but also among those with many years to live. Treatment care gaps may reflect clinicians' synthesis about frailty and life-expectancy gains.<br /> (© 2014 American Heart Association, Inc.)
- Subjects :
- Aged
Aged, 80 and over
Female
Follow-Up Studies
Humans
Male
Myocardial Infarction mortality
Ontario epidemiology
Prognosis
Retrospective Studies
Risk Factors
Survival Rate trends
Time Factors
Delivery of Health Care methods
Life Expectancy
Myocardial Infarction therapy
Myocardial Revascularization methods
Subjects
Details
- Language :
- English
- ISSN :
- 1941-7705
- Volume :
- 7
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Circulation. Cardiovascular quality and outcomes
- Publication Type :
- Academic Journal
- Accession number :
- 24895449
- Full Text :
- https://doi.org/10.1161/CIRCOUTCOMES.113.000795