Guideline-recommended therapies for acute coronary syndromes (ACS) derive from randomized trials in which elderly patients are underrepresented. Although numbers of this population are increasing, they are largely undertreated in the real world.
The study evaluates the impact of older age on care for patients with ACS admitted to the Italian Intensive Cardiac Care Units (ICCUs) network.
We analyzed data from the BLITZ-3 Registry in order to assess in-hospital care among unselected elderly patients (≥75 years).
From 7–20 April 2008, 6986 consecutive patients with acute cardiac conditions were admitted to ICCUs and prospectively enrolled; 3636 (52%) had ACS and 38% of them were elderly. Elderly patients had a higher risk profile, their median length of stay in ICCU was longer [4 days, interquartile range (IQR): 3–6 vs. 3 days, IQR: 2–5; P < 0.0001] and guideline-recommended care was applied less often. At multivariable analysis, elderly patients were less likely to receive reperfusion [odds ratio (OR) = 0.53, 95% confidence interval (CI) = 0.42–0.67] for ST-elevation, or early coronary angiography (OR = 0.45, 95% CI = 0.37–0.56) for non-ST elevation ACS. Besides, unadjusted in-ICCU total mortality was higher for elderly patients with ST-elevation (11.8% elderly vs. 1.8% younger patients; P < 0.0001) or non-ST-elevation (3.9% elderly vs. 0.6% younger patients; P < 0.0001) ACS.
In a nationwide survey, age impacts on care. The elderly with ACS have a higher risk profile but receive less guideline-recommended care than younger patients. Thus, further improvements in care of this population should be pursued.
aCardiology Department, Maggiore Hospital, Bologna
bCardiology Department, G. Brotzu-S. Michele Hospital, Cagliari
cCardiology Department, Santa Maria degli Angeli Hospital, Pordenone
dCardiology Department, Santa Corona Hospital, Pietra Ligure
eCardiology Department, Maria Vittoria Hospital
fCardiology Department, Mauriziano Hospital, Torino
gCardiology Department 1, Careggi Hospital
hANMCO Research Center, Firenze
iCardiology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
*See acknowledgement section for a complete list of participating centers and investigators.
Correspondence to Gianni Casella, MD, BLITZ-3 Coordinating Center, ANMCO Research Center, Via La Marmora 34 – 50121 Firenze, ItalyTel: +39 055 5101361; fax: +39 055 5101320; e-mail: email@example.com
Received 21 July, 2011
Revised 2 September, 2011
Accepted 30 November, 2011