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Older patients with acute coronary syndromes not getting recommended treatment

n procedures, angioplasty or coronary artery bypass surgery. Most medications prescribed at hospital discharge were similar across all age groups; however, elderly patients were less likely to receive clopidogrel (an anti-platelet drug meant to reduce the risk of blood clots) or cholesterol-lowering drugs. The differences were apparent even after adjusting the treatment data to take into account known contraindications to treatment and other diseases that might have influenced treatment decisions.

The researchers also noted that although death rates and complications rose with advancing age, elderly patients who received more recommended therapies were less likely to die than those who did not.

Dr. Alexander said that progress is being made toward providing recommended treatment to patients of all ages, but this study shows there is more work to be done.

"Awareness of gaps is the first step in narrowing them. Further work on lipid lowering in the very elderly, and early identification of acute coronary syndrome symptoms in the aged, are areas which will benefit from continued work," she said.

Dr. Alexander noted that hospitals volunteer to participate in CRUSADE and they receive web-based educational sessions about the treatment of acute coronary syndromes. The study focused on the specific treatments recommended by ACC/AHA guidelines, so it did not collect data on aspects of care or details of other illnesses patients may have had. However, she said that enrollment was specific to patients with an acute coronary syndrome, and that the large number of hospitals and patients should provide a fairly representative view of current clinical practice.

H. Vernon Anderson, M.D., F.A.C.C., from the University of Texas Health Science Center at Houston, who wrote an editorial in the journal with Richard G. Bach, M.D., F.A.C.C. from the Washington University Medical Center in St. Louis, Missouri, said this report is part of an extremely
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Contact: Amy Murphy
amurphy@acc.org
301-581-3476
American College of Cardiology
11-Oct-2005


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