OBJECTIVES
To examine secular trends in the use of evidence-based therapies in a geographically
defined cohort of patients with myocardial infarction (MI) and to test the hypotheses
that baseline use is increasing and that disparities in use are diminishing.
PATIENTS AND METHODS
All consecutively hospitalized patients who were dismissed from Olmsted County, Minnesota,
hospitals between 1979 and 1998 with a diagnosis of MI were identified using standardized
criteria (biomarkers, cardiac pain, and electrocardiography). The entire community
medical record, available via the Rochester Epidemiology Project, was reviewed to
ascertain baseline characteristics including comorbidity, presence of ST-segment elevation
on electrocardiography, and treatment. Logistic regression models were used to examine
the association of treatment with age and sex, independent of other baseline characteristics.
RESULTS
Between 1979 and 1998, 2317 incident MIs (patient mean ± SD age, 67±14 years; 43%
women; 57% aged ≥65 years) occurred in Olmsted County. The use of all evidence-based
therapies increased over time, primarily reflecting the introduction of these medications
at the time of index MI. Between 1989 and 1998, age was not independently associated
with use of aspirin or ACE inhibitors. Disparities in use persisted for reperfusion
therapy and ¥-blockers. Reperfusion therapy or revascularization was used less frequently
in older persons, particularly in elderly women (P<.001). Use of ¥-blockers decreased 16% among persons aged 65 years or older, independent
of measurable differences in baseline characteristics and MI severity (hazard ratio,
0.84; 95% confidence interval, 0.74-0.93).
CONCLUSIONS
The use of all evidence-based therapies for MI increased markedly over time; however,
residual gaps in use were noted. Reperfusion therapy or revascularization is used
less frequently in women and elderly persons, and ¥-blockers are used less frequently
in elderly persons. These differences are not explained by measurable differences
in baseline characteristics. Women and elderly persons represent an increasing proportion
of patients with MIs in the community; therefore, these findings define therapeutic
opportunities.
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Article Info
Footnotes
This study was supported in part by grants (AR30582 and RO1HL59205) from the Public Health Service and the National Institutes of Health. Dr Roger is an Established Investigator of the American Heart Association.
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Copyright
© 2004 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
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- Clinical Epidemiology, Clinical Care, and the Public's HealthMayo Clinic ProceedingsVol. 79Issue 8
- PreviewClinical epidemiology is the “science of making predictions about individual patients…using strong scientific methods” to “obtain the kind of information clinicians need to make good decisions in the care of patients.”1 Although randomized clinical trials are cited routinely as the highest form of clinical epidemiology,2 recent interest has focused on the ability of observational methods to yield valuable insights into the nature and effect of treatments of common and serious diseases that represent major threats to the public's health.
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