Author + information
- Claes Held,
- Per Johanson,
- Annika Edberg,
- Olle Bergström,
- Jörgen Cronblad,
- Karin Hellström Angerud,
- Thomas Kellerth,
- Johan Lugnegård,
- Ewa Mattsson,
- Anette Sandström,
- Monica Sterner,
- Lars Wallentin and
- Tomas Jernberg
Patients with acute coronary syndrome (ACS) above the age of 80 are increasingly common, but underrepresented in clinical trials and might not always receive treatment according to guidelines recommendation.
Patients above or below or equal to 80 years (n=13525) treated in Sweden 2011 in SWEDEHEART, a national registry in Sweden, were compared in terms of risk factors, in-hospital treatment, revascularization, and mortality.
The proportion of patients >80 years was 31% (n=6074) and 5% (n=1071) were >90 years. The elderly were more often women, had more often hypertension, previous myocardial infarction (MI), heart failure and stroke and accordingly on admission more often had treatment with beta-blockers, aspirin and ACE-inhibitors. Patients above compared to below 80 less often presented with ST-elevation MI /left bundle branch block (STEMI/LBBB) (25% vs 35%); reperfusion treatment was less common (60% vs 82%) and less often performed within recommended time frames (68% vs 73%). Elderly patients with non-ST elevation MI with high risk criteria above compared to <80 years underwent coronary angiography considerably less often (36% vs 85%) with a large variability between hospitals (9–92%). Revascularization with percutaneous coronary intervention occurred in 15%. Evidence based secondary preventive therapy was less used at discharge in the elderly, such as lipid lowering drugs (71% vs 96%), clopidogrel (78% vs 95%), ACE-inhibitors/ARB (74% vs 89%). In-hospital and 30-day mortality in those above compared to <80 was higher; 10% vs 2.5% and 13% vs 3.5%, respectively. In patients >80, the in-hospital; 30-day and 1 year mortality has decreased considerably from 1995 to 2011 from 21.7% to 9.8%; 25.9% to 13.2%, and 43.6% to 31.9%, respectively, which is a larger absolute reduction than in younger patients.
Patients with ACS >80 years have a higher cardiovascular risk but receive less guideline recommended acute and long-term treatment despite similar improvements in outcomes over the years as younger patients. Undertreatment of elderly patients with ACS seems to be a remaining problem contributing to a high mortality.
West, Room 3020
Saturday, March 09, 2013, 8:15 a.m.-8:30 a.m.
Session Title: ACS: Vulnerable and Underrepresented Populations
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 902-4
- 2013 American College of Cardiology Foundation