TY - JOUR 
A1 - Ariza Solé, Albert
AU - Alegre, Oriol
AU - Elola, Francisco Javier
AU - Fernández Pérez, Cristina
AU - Formiga, Francesc
AU - Martínez Sellés Oliveria Soares, Manuel
AU - Bernal, José Luis
AU - Segura, José V.
AU - Iñíguez, Andrés
AU - Cequier, Ángel
AU - Et al.
T1 - Management of myocardial infarction in the elderly. Insights from Spanish Minimum Basic Data Set
Y1 - 2019
SN - 2048-8726

UR - http://hdl.handle.net/11268/8046
AB - Background:
We aimed to assess the impact of implementation of reperfusion networks, the type of hospital and specialty of the treating physician on the management and outcomes of ST segment elevation myocardial infarction in patients aged ⩾75 years.

Methods:
We analysed data from the Minimum Basic Data Set of the Spanish public health system, assessing hospital discharges between 2004 and 2013. Discharges were distributed in three groups depending on the clinical management: percutaneous coronary intervention, thrombolysis or no reperfusion. Primary outcome measure was all cause in-hospital mortality. For risk adjustment, patient comorbidities were identified for each index hospitalization.

Results:
We identified 299,929 discharges, of whom 107,890 (36%) were in-patients aged ⩾75 years. Older patients had higher prevalence of comorbidities, were less often treated in high complexity hospitals and were less frequently managed by cardiologists (p<0.001). Both percutaneous coronary intervention and fibrinolysis were less often performed in elderly patients (p<0.001). A progressive increase in the rate of percutaneous coronary intervention was observed in the elderly across the study period (from 17% in 2004 to 45% in 2013, p<0.001), with a progressive reduction of crude mortality (from 23% in 2004 to 19% in 2013, p<0.001). Adjusted analysis showed an association between being treated in high complexity hospitals, being treated by cardiologists and lower in-hospital mortality (p <0.001).

Conclusions:
Elderly patients with ST segment elevation myocardial infarction are less often managed in high complexity hospitals and less often treated by cardiologists. Both factors are associated with higher in-hospital mortality.
KW - Servicios de salud
KW - Infarto de miocardio
KW - España
KW - Política de la salud
KW - Enfermedad cardiovascular
KW - España
LA - eng
ER -