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Age-related differences in in-hospital mortality and the use of thrombolytic therapy for acute myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature194746
Source
CMAJ. 2001 May 1;164(9):1285-90
Publication Type
Article
Date
May-1-2001
Author
J M Boucher
N. Racine
T H Thanh
E. Rahme
J. Brophy
J. LeLorier
P. Théroux
Author Affiliation
Département de Médecine, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Que.
Source
CMAJ. 2001 May 1;164(9):1285-90
Date
May-1-2001
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged
Aged, 80 and over
Analysis of Variance
Comorbidity
Confounding Factors (Epidemiology)
Drug Utilization
Electrocardiography
Female
Guideline Adherence - statistics & numerical data
Hospital Mortality
Humans
Logistic Models
Male
Middle Aged
Myocardial Infarction - diagnosis - drug therapy - etiology - mortality
Patient Selection
Physician's Practice Patterns - statistics & numerical data
Practice Guidelines as Topic
Predictive value of tests
Prospective Studies
Quebec - epidemiology
Registries
Risk factors
Thrombolytic Therapy - utilization
Abstract
Recent guidelines have acknowledged that thrombolysis decreases mortality from acute myocardial infarction (AMI) independently of age. The purpose of this study was to determine the age-related rates of thrombolytic administration and in-hospital mortality and the variables related to the use of thrombolytic therapy for patients with AMI.
A prospective cohort analysis involved a registry of 44 acute care Quebec hospitals that enrolled 3741 patients with AMI between January 1995 and May 1996. The main outcomes of interest were crude and adjusted age-related in-hospital mortality rates and rates of use of thrombolytic therapy.
In-hospital mortality rates increased dramatically with age from 2.1% in patients with AMI who were less than 55 years of age to 26.3% in those who were 85 years of age or older. Overall, 35.8% of the patients received thrombolysis. There was a pronounced inverse gradient in the use of thrombolysis with age, ranging from 46.2% in the youngest age group ( or = 85 years). After adjustment for potential confounders, the older patients remained significantly less likely to receive thrombolytic therapy. Compared with patients who were less than 55 years of age, the odds ratio of receiving thrombolytic therapy was 0.68 (95% confidence interval [CI] 0.52-0.89) for patients aged 65-74 years, 0.48 (95% CI 0.35-0.65) for patients aged 75-84 years and 0.13 (95% CI 0.06-0.26) for patients aged 85 years or more. Other variables related to thrombolytic therapy were diabetes (odds ratio [OR] 0.77, 95% CI 0.59-1.00), cerebrovascular disease (OR 0.46, 95% CI 0.30-0.72), angina (OR 0.73, 95% CI 0.56-0.95), typical chest pain (OR 2.56, 95% CI 1.88-3.47); ST elevation (OR 8.93, 95% CI 7.24-11.00), Q wave MI (OR 5.26, 95% CI 4.20-6.60) and increased length of time between onset of symptoms and arrival at hospital.
Age is an important independent predictor of in-hospital mortality and lower thrombolytic use following AMI. Other studies are required to further evaluate the appropriateness of thrombolytic therapy for elderly patients.
Notes
Cites: Arch Intern Med. 1994 May 23;154(10):1090-68185422
Cites: Lancet. 1994 Feb 5;343(8893):311-227905143
Cites: Can J Cardiol. 1994 Jun;10(5):522-98012880
Cites: Arch Intern Med. 1994 Oct 10;154(19):2202-87944841
Cites: Ann Intern Med. 1996 Feb 1;124(3):283-918554222
Cites: J Am Coll Cardiol. 1996 Nov 1;28(5):1328-4288890834
Cites: N Engl J Med. 1997 Mar 20;336(12):847-609062095
Cites: Arch Intern Med. 1997 Apr 14;157(7):741-69125005
Cites: JAMA. 1997 Jun 4;277(21):1683-89169894
Cites: Ann Intern Med. 1997 Oct 1;127(7):538-569313022
Cites: CMAJ. 1998 Feb 24;158(4):475-809627559
Cites: Circulation. 1999 Aug 31;100(9):1016-3010468535
Cites: Can J Cardiol. 1994 Jun;10(5):517-218012879
Cites: Circulation. 2000 May 16;101(19):2239-4610811589
Cites: N Engl J Med. 1986 Jun 5;314(23):1465-712871492
Cites: Lancet. 1988 Mar 12;1(8585):545-92894490
Cites: Lancet. 1988 Aug 13;2(8607):349-602899772
Cites: Lancet. 1988 Sep 3;2(8610):525-302900919
Cites: Lancet. 1990 Jul 14;336(8707):65-711975321
Cites: Ann Intern Med. 1990 Dec 15;113(12):949-602240919
Cites: JAMA. 1991 Jul 24-31;266(4):528-322061979
Cites: Lancet. 1992 Mar 28;339(8796):753-701347801
Cites: JAMA. 1992 Nov 11;268(18):2530-61404820
Cites: Ann Intern Med. 1993 Feb 1;118(3):201-108417638
Cites: N Engl J Med. 1993 Mar 18;328(11):779-848123063
Cites: N Engl J Med. 1993 Nov 11;329(20):1442-88413454
Comment In: CMAJ. 2001 May 1;164(9):1301-311341140
PubMed ID
11341137 View in PubMed
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Age-related differences in the management and outcome of patients with acute coronary syndromes.

https://arctichealth.org/en/permalink/ahliterature170984
Source
Am Heart J. 2006 Feb;151(2):352-9
Publication Type
Article
Date
Feb-2006
Author
Raymond T Yan
Andrew T Yan
Mary Tan
Chi-Ming Chow
David H Fitchett
Frank L Ervin
James Y M Cha
Anatoly Langer
Shaun G Goodman
Author Affiliation
Division of Cardiology, Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Source
Am Heart J. 2006 Feb;151(2):352-9
Date
Feb-2006
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Angina, Unstable - mortality - therapy
Canada
Comorbidity
Epidemiologic Methods
Evidence-Based Medicine - statistics & numerical data
Female
Fibrinolytic Agents - administration & dosage
Hospital Mortality
Humans
Male
Middle Aged
Myocardial Infarction - mortality - therapy
Myocardial Revascularization - methods - utilization
Registries
Syndrome
Thrombolytic Therapy - utilization
Treatment Outcome
Abstract
Age-related differences in patients with an acute coronary syndrome (ACS) have not been well characterized in prior observational studies that often included only certain age groups or subjects with myocardial infarction (MI).
We stratified 4627 patients admitted with an ACS across 9 provinces between 1999 and 2001 enrolled in the Canadian ACS Registry into 3 age groups ( or = 75 years) to evaluate differences in clinical characteristics, management, and 1-year outcome.
Older patients more frequently had previous angina, MI, or heart failure and were less likely to have positive cardiac markers, ST elevation, and Q-wave MI or to receive thrombolytics, beta-blockers, and cholesterol-lowering and antiplatelet agents in hospital, at discharge, and at 1 year. In multivariable analyses controlling for patient factors, every decade increase in age was independently associated with reduced use of coronary angiography (odds ratio [OR] 0.79, 95% CI 0.74-0.84, P
PubMed ID
16442898 View in PubMed
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Analysis of Canadian population with potential geographic access to intravenous thrombolysis for acute ischemic stroke.

https://arctichealth.org/en/permalink/ahliterature204047
Source
Stroke. 1998 Nov;29(11):2304-10
Publication Type
Article
Date
Nov-1998
Author
P A Scott
C J Temovsky
K. Lawrence
E. Gudaitis
M J Lowell
Author Affiliation
Section of Emergency Medicine, Department of Surgery, University of Michigan Medical Center, Ann Arbor, Mich., and Hoffmann-La Roche, Ltd (Canada), Toronto, Canada. phillip.scott@umich.edu
Source
Stroke. 1998 Nov;29(11):2304-10
Date
Nov-1998
Language
English
Publication Type
Article
Keywords
Acute Disease
Adult
Age Distribution
Aged
Aged, 80 and over
Brain Ischemia - drug therapy - ethnology
Canada - epidemiology
Educational Status
Emergency Medical Services - utilization
Ethnic Groups - statistics & numerical data
Female
Health Services Accessibility
Hospitals - utilization
Humans
Injections, Intravenous
Male
Middle Aged
Plasminogen Activators - administration & dosage
Thrombolytic Therapy - utilization
Abstract
We sought to identify the Canadian population with potential access to intravenous tissue plasminogen activator within 3 hours of onset of acute ischemic stroke.
Assuming that 60 minutes is needed for stroke recognition, emergency room evaluation, and administration of tissue plasminogen activator, 120 minutes remain for transport, using a 3-hour treatment window. Ambulance databases were analyzed for transport times of 60, 90, and 120 minutes and were found to correspond to transport distances of 32, 64, and 105 kilometers (20, 40, and 65 miles), respectively. Using Geographical Information System (GIS) software, these radii were overlaid on thematic maps of Canadian hospitals identified as having a third- or fourth-generation CT and with a neurologist and an emergency physician on staff. Analysis was then performed on complete Canadian census data from 1991 and the interim 1996 census count.
67.3%, 78.2%, and 85.3% of the total Canadian population were within 32, 64, and 105 kilometers, respectively, of an identified hospital. For individuals >/=65 years of age, 64.4%, 77.0%, and 85.7% were within the respective radii. Complete analysis by age, ethnic origin, and gender are detailed.
In the model described, a substantial percentage of the Canadian population has geographic access to a hospital potentially capable of delivering intravenous thrombolysis for acute ischemic stroke. GIS analysis can identify both population groups and rural areas with limited access to thrombolytic stroke treatment. A coordinated emergency medical service response for stroke is advocated to maximize coverage, as a 60-minute delay in emergency room arrival eliminated 5.1 million people from potential treatment.
PubMed ID
9804638 View in PubMed
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Answering the hard questions about thrombosis.

https://arctichealth.org/en/permalink/ahliterature205262
Source
CMAJ. 1998 Jun 16;158(12):1600-1; author reply 1602
Publication Type
Article
Date
Jun-16-1998
Author
M. Schull
Source
CMAJ. 1998 Jun 16;158(12):1600-1; author reply 1602
Date
Jun-16-1998
Language
English
Publication Type
Article
Keywords
Cardiology - standards
Emergency Service, Hospital - standards
Health Services Misuse - statistics & numerical data
Humans
Myocardial Infarction - drug therapy
Quebec
Thrombolytic Therapy - utilization
Time Factors
Notes
Comment In: CMAJ. 1998 Oct 6;159(7):757-89805012
Comment On: CMAJ. 1998 Feb 24;158(4):475-809627559
PubMed ID
9645171 View in PubMed
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Application of Lean Six Sigma for patients presenting with ST-elevation myocardial infarction: the Hamilton Health Sciences experience.

https://arctichealth.org/en/permalink/ahliterature170153
Source
Healthc Q. 2006;9(1):56-61, 2
Publication Type
Article
Date
2006
Author
Ayad Aldarrab
Author Affiliation
Royal College Residency Training Program, McMaster University, Hamilton, Ontario. Edarrab@hotmail.com
Source
Healthc Q. 2006;9(1):56-61, 2
Date
2006
Language
English
Publication Type
Article
Keywords
Benchmarking
Crowding
Electric Countershock - utilization
Electrocardiography - utilization
Emergency Service, Hospital - standards - utilization
Humans
Institutional Management Teams
Models, organizational
Myocardial Infarction - diagnosis - drug therapy
Ontario
Practice Guidelines as Topic
Process Assessment (Health Care)
Quality Assurance, Health Care
Software Design
Thrombolytic Therapy - utilization
Time Factors
Abstract
Most patients with symptomatic acute myocardial infarction (AMI), the leading cause of death in western industrialized nations, use the emergency department (ED) as their point of entry. Yet, one identified barrier to early recognition of patients with AMI is ED overcrowding. In this paper, the author presents a quality improvement model that applies Lean Six Sigma guidelines to the clinical setting.
Notes
Erratum In: Healthc Q. 2006;9(2):16
PubMed ID
16548435 View in PubMed
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Clinical findings, outcome and treatment in patients > or = 75 years with acute myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature183657
Source
Eur J Epidemiol. 2003;18(8):781-6
Publication Type
Article
Date
2003
Author
Mervi Kotamäki
Timo E Strandberg
Markku S Nieminen
Author Affiliation
Department of Medicine, Division of Cardiology, University of Helsinki, Finland. mervi.kotamaki@hus.fi
Source
Eur J Epidemiol. 2003;18(8):781-6
Date
2003
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Female
Finland - epidemiology
Hospital Mortality
Hospitals, Teaching
Humans
Logistic Models
Male
Myocardial Infarction - complications - drug therapy - mortality
Pneumonia - complications
Registries
Risk factors
Sex Factors
Thrombolytic Therapy - utilization
Treatment Outcome
Abstract
Treatment of acute myocardial infarction (AMI) has changed dramatically during the 1990s, and the patients are older. Our aim was to characterize current clinical course, medication and invasive treatment in elderly patients with AMI, compare treatment between sexes and also with data from 1994.
The study population included all patients aged > or = 75 years (n = 197, 68% female), who were admitted from January 1997 to December 1998 to our hospital because of AMI.
Sixty-six percent of both sexes had non-Q AMI. Peak creatine kinase (CK)-MB fraction values were significantly higher in men (p = 0.035). Thrombolysis was performed on 16% and coronary angiography, coronary angioplasty/cardiac surgery on 8% of patients each. In-hospital mortality was high (25%). Cholesterol-lowering agents were used for only 8% of patients. During hospitalization, 15% of patients had an infection requiring intravenous antibiotics. Multivariate analysis revealed that infection increased in-hospital mortality 2.90-fold (95% CI: 1.23-6.82) and congestive heart failure (CHF) 2.25-fold (95% CI: 1.02-4.97). Post-discharge mortality was 10% during the median follow-up of 12 months; 75% of deaths were due to re-infarction. Compared with the year 1994, the use of beta-blockers (84 vs. 70%, p = 0.010) and angiotensin-converting enzyme inhibitors (43 vs. 31%, p = 0.062) had increased, and digitalis (27 vs. 43%, p = 0.0065) and calcium antagonists (13 vs. 26%, p = 0.0086) had decreased.
Treatment and hospital course of AMI in these elderly patients did not differ between sexes. Although drug treatments have become more evidence-based during the end of 1990s, in-hospital mortality was still high and more effective prevention, effective treatment of infections and CHF may be important for improving prognosis.
PubMed ID
12974554 View in PubMed
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Comparative assessment of ECG dynamics in myocardial infarction according to reperfusion therapy approach (primary and facilitated coronary angioplasty) and timing of the procedure.

https://arctichealth.org/en/permalink/ahliterature162199
Source
Anadolu Kardiyol Derg. 2007 Jul;7 Suppl 1:171-4
Publication Type
Article
Date
Jul-2007
Author
G V Ryabykina
A V Sozykin
S V Dobrovolskaya
Author Affiliation
Russian Cardiology Research Center, Moscow, Russia. anrogoza@cardio.ru
Source
Anadolu Kardiyol Derg. 2007 Jul;7 Suppl 1:171-4
Date
Jul-2007
Language
English
Publication Type
Article
Keywords
Aged
Angioplasty, Balloon, Coronary - utilization
Electrocardiography
Humans
Middle Aged
Myocardial Infarction - epidemiology - physiopathology - therapy
Outcome Assessment (Health Care)
Russia - epidemiology
Thrombolytic Therapy - utilization
Time Factors
Abstract
The aim of this study was to compare electrocardiogram (ECG)-12 dynamics depending on the methods of facilitated and primary angioplasty in patients with acute coronary syndrome. The ECG changes in 81 patients - 73 patients with acute myocardial infarction and 8 patients with unstable angina pectoris - were studied.
The ECG analysis before reperfusion therapy and after angioplasty included: dynamics of summary elevation (Sigma ST+) and depression (Sigma ST-) of ST segment and changes of summary value of R waves (Sigma R) in 12 leads. The results were estimated with consideration for the length of the period from the beginning of pain syndrome till treatment and topics of the infraction-related artery.
According to our data, there was no difference between facilitated and primary transluminal coronary angioplasty in their effect on focal myocardial variation dynamics and the size of peri-infarction zone.
A reliable decrease in elevation and depression of ST segment was observed in reperfusion therapy not later than 6 hours after the beginning of pain syndrome. When reperfusion therapy is begun later, dynamics of summary values of ST segment elevation and depression before and after treatment are not reliable.
PubMed ID
17584716 View in PubMed
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Country mouse/city mouse: differences in Canadian and American care of the ST-elevation myocardial infarction patient.

https://arctichealth.org/en/permalink/ahliterature196751
Source
Can J Cardiol. 2000 Oct;16(10):1219-21
Publication Type
Article
Date
Oct-2000
Author
B J O'Neill
J L Cox
Source
Can J Cardiol. 2000 Oct;16(10):1219-21
Date
Oct-2000
Language
English
Publication Type
Article
Keywords
Canada
Coronary Angiography - utilization
Cross-Cultural Comparison
Humans
Myocardial Infarction - drug therapy - mortality
Survival Rate
Thrombolytic Therapy - utilization
United States
Notes
Comment On: Can J Cardiol. 2000 Oct;16(10):1231-911064297
PubMed ID
11064294 View in PubMed
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Door to thrombolysis: ER reorganization and reduced delays to acute stroke treatment.

https://arctichealth.org/en/permalink/ahliterature168203
Source
Neurology. 2006 Jul 25;67(2):334-6
Publication Type
Article
Date
Jul-25-2006
Author
P J Lindsberg
O. Häppölä
M. Kallela
L. Valanne
M. Kuisma
M. Kaste
Author Affiliation
Emergency Neurology Services, Department of Neurology, Biomedicum Helsinki,Helsinki, Finland. perttu.lindsberg@hus.fi
Source
Neurology. 2006 Jul 25;67(2):334-6
Date
Jul-25-2006
Language
English
Publication Type
Article
Keywords
Acute Disease
Emergency Service, Hospital - organization & administration
Finland - epidemiology
Hospital Restructuring - organization & administration
Hospitalization - statistics & numerical data
Humans
Stroke - therapy
Thrombolytic Therapy - utilization
Time Management - organization & administration
Triage - organization & administration
Abstract
The authors reorganized the emergency room (ER) by moving CT to the ER and streamlining triage by prenotification by emergency medical services (EMS), which reduced in-hospital delays and enhanced access to stroke thrombolysis. CT delay dropped from 1 hour 3 minutes +/- 14 minutes in 1999 to 7 +/- 2 minutes in 2004 (p
PubMed ID
16864834 View in PubMed
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Factors associated with pre-hospital and in-hospital delay time in acute myocardial infarction: a 6-year experience.

https://arctichealth.org/en/permalink/ahliterature48087
Source
J Intern Med. 1998 Mar;243(3):243-50
Publication Type
Article
Date
Mar-1998
Author
M. Berglin Blohm
M. Hartford
T. Karlsson
J. Herlitz
Author Affiliation
Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
Source
J Intern Med. 1998 Mar;243(3):243-50
Date
Mar-1998
Language
English
Publication Type
Article
Keywords
Aged
Emergency Service, Hospital - standards
Female
Hospitals, University
Humans
Male
Medical Audit
Middle Aged
Multivariate Analysis
Myocardial Infarction - drug therapy - therapy
Patient Admission - statistics & numerical data
Prospective Studies
Sweden
Thrombolytic Therapy - utilization
Time Factors
Time and Motion Studies
Abstract
OBJECTIVES: To explore factors associated with delay time prior to hospital admission and in hospital amongst acute myocardial infarction (AMI) patients with particular emphasis on the delay time to the administration of thrombolytic therapy. METHODS: During a 6-year period we prospectively computerized pre-hospital and in-hospital time intervals for AMI patients admitted to the coronary care unit (CCU) direct from the emergency department (ED) or via paramedics, at Sahlgrenska Hospital, Göteborg, Sweden. RESULTS: Pre-hospital delay: independent predictors of a prolonged delay were increased age (P = 0.0007), female sex (P = 0.02) and a history of hypertension (P = 0.03). For AMI patients who received thrombolytic treatment and the only independent predictor of a prolonged delay was increased age (P = 0.005). In-hospital delay: for all AMI patients independent predictors of a prolonged delay were prolonged pre-hospital delay (P
PubMed ID
9627162 View in PubMed
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26 records – page 1 of 3.