ACUTE MYOCARDIAL-INFARCTION IN THE MEDICARE POPULATION - PROCESS OF CARE AND CLINICAL OUTCOMES
ACUTE MYOCARDIAL-INFARCTION IN THE MEDICARE POPULATION - PROCESS OF CARE AND CLINICAL OUTCOMES
复制标题
DOI：
10.1001/jama.268.18.2530
复制
发表时间：
1992-11-11
影响因子：
120.7
通讯作者：
MCNEIL, BJ
中科院分区：
文献类型：
--
作者：
UDVARHELYI, IS;GATSONIS, C;MCNEIL, BJ
目的：描述医疗保险人群中与急性心肌梗死(AMI)相关的护理过程和临床结果，并检验护理过程和护理结果的差异作为患者年龄、性别和种族的函数。设计-使用从医疗保险利用和管理文件创建的纵向数据库进行的回溯性队列研究。患者群体。-1987年联邦医疗保险覆盖的急性心肌梗死患者队列和没有急性心肌梗死的医疗保险患者的随机样本。主要过程和结果测量。-(1)新的急性心肌梗死后最初90天内冠状动脉造影、冠状动脉旁路移植手术和经皮冠状动脉腔内成形术的使用；(2)30天、1年和2年的死亡率；(3)再梗死率；(4)冠状动脉搭桥术和经皮冠状动脉腔内成形术的再手术率。主要结果：死亡率高：30天的死亡率为26%，1年的死亡率为40%，2年的死亡率为47%。年龄差异很大，性别和种族差异较小，即使在前30天存活的患者中也很高。与死亡率相比，再梗塞并不常见，7.3%的患者会发生再梗塞。在最初的90天里，23%的患者接受了血管造影术，13%的患者接受了冠状动脉血管重建术(冠状动脉搭桥术，8%；经皮冠状动脉腔内成形术，5%)。所有这三种手术的使用率都随着年龄的增长而减少，在女性和黑人中的使用情况比在男性和白人中要少。不同年龄和种族的血管造影术比血管重建术更能区分年龄和种族。结论：65岁及以上的急性心肌梗死患者的预后比通常认为的要差得多。在这些患者中，手术程序的使用因性别和种族的不同而不同，尽管死亡率没有变化。需要进一步的研究来降低老年急性心肌梗死患者的死亡率，并了解基于社会人口学特征的不同程序使用的意义。
Objective.-To describe the process of care and clinical outcomes associated with acute myocardial infarction (AMI) in the Medicare population, and to examine differences in process of care and outcome of care as a function of patient age, gender, and race.Design.-Retrospective cohort study using a longitudinal database created from Medicare utilization and administrative files.Patient Populations.-A cohort of AMI patients covered by Medicare in 1987 and a random sample of Medicare patients without AMI.Main Process and Outcome Measurements.-(1) The use of coronary angiography, coronary artery bypass graft surgery, and percutaneous transluminal coronary angioplasty during the first 90 days after a new AMI; (2) mortality at 30 days, 1 year, and 2 years; (3) reinfarction rates; and (4) reoperation rates for coronary artery bypass graft surgery and percutaneous transluminal coronary angioplasty.Main Results.-Mortality rates were high: 26% at 30 days, 40% at 1 year, and 47% at 2 years. They varied greatly by age, less so by gender and race, and were high even among patients who survived the first 30 days. Compared with mortality, reinfarction was uncommon, occurring in 7.3% of patients. During the first 90 days, 23% of all patients underwent angiography and 13% underwent coronary revascularization (coronary artery bypass graft surgery, 8%; percutaneous transluminal coronary angioplasty, 5%). The use of all three procedures decreased with age and was less common among women and blacks than among men and whites. Differential use by age and race was greater for angiography than for revascularization procedures.Conclusions.-The prognosis following AMI in patients aged 65 years and above is much worse than is commonly realized. Procedure use in these patients varies as a function of gender and race, even though mortality does not. Further research is needed to reduce the mortality of elderly patients with AMI and to understand the significance of differences in procedure use on the basis of sociodemographic characteristics.