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Adherence to MI Guidelines Increases Survival in Elderly Medicare Patients
Adhering to treatment guidelines for patients hospitalized with acute myocardial infarction (MI) improves survival and extends life expectancy, according to the results of a new study in the Journal of the American College of Cardiology.
Guideline-based therapies for patients admitted to the hospital with acute MI include aspirin and beta-blockers within 48 hours of admission; acute reperfusion therapy, either with percutaneous coronary intervention (PCI) or fibrinolysis, within 24 hours of admission; and having a “door-to-balloon” time of no more than 90 minutes and a time to fibrinolysis of no more than 30 minutes.
Researchers analyzed long-term data for 147,429 Medicare patients eligible for one of the guideline-based admission therapies and who had 17 years of follow-up, all of whom participated in the Cooperative Cardiovascular Project. They compared survival for recipients and nonrecipients of these guideline-based therapies.
Treatment with aspirin within the first 48 hours of hospitalization was associated with a significant reduction in mortality at 30 days compared with no aspirin, and the survival benefit was maintained until 5 years. The survival benefit of receiving a beta-blocker within 48 hours of hospitalization and undergoing acute reperfusion therapy within 24 hours of hospitalization were also associated with a significant reduction in mortality throughout the 17-year follow-up period.
After adjustment, treatment with aspirin, beta-blockers, and acute reperfusion therapy was associated with 0.65, 0.45, and 0.90 years of life gained, respectively. Patients treated with a door-to-balloon time ≤ 90 minutes gained 0.98 years of life, and those with a door-to-fibrinolysis time ≤ 30 minutes gained 0.52 years of life.
“This study strengthens the case for why rapid and early delivery of acute MI admission guidelines is important,” the authors wrote.
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