NYMC Faculty Publications

Management and Outcomes of ST-Elevation Myocardial Infarction in Nursing Home Versus Community-Dwelling Older Patients: A Propensity Matched Study

Author Type(s)

Faculty

DOI

10.1016/j.jamda.2014.04.017

Journal Title

Journal of the American Medical Directors Association

First Page

593

Last Page

599

Document Type

Article

Publication Date

8-1-2014

Department

Medicine

Keywords

Aged, Aged, 80 and over, Female, Hospital Mortality, Humans, Male, Myocardial Infarction, Nursing Homes, Patient Admission, Propensity Score, Retrospective Studies, Risk Factors, Treatment Outcome, United States

Disciplines

Medicine and Health Sciences

Abstract

OBJECTIVES: The influence of admission source (nursing home [NH] versus community-dwelling) on treatment strategies and outcomes among elderly patients with ST-elevation myocardial infarction (STEMI) has not been investigated.

PARTICIPANTS: Nationwide Inpatient Sample databases from 2003 to 2010 were used to identify 270,117 community-dwelling and 4082 NH patients 75 years of age or older with STEMI.

DESIGN: Retrospective observational study.

MEASUREMENTS: Propensity scores for admission source were used to assemble a matched cohort of 3081 community-dwelling and 3132 NH patients, who were balanced on baseline demographic and clinical characteristics. Bivariate logistic regression models were then used to determine the associations of NH with in-hospital outcomes among matched patients.

RESULTS: In-hospital mortality was significantly higher in patients with STEMI presenting from a NH as compared with community-dwelling patients (30.5% versus 27.6%; odds ratio [OR] 1.15, 95% confidence interval [CI] 1.03-1.29; P = .012). Overall, NH patients were less likely to receive reperfusion (thrombolysis, percutaneous coronary intervention, or coronary artery bypass grafting) (11.5% versus 13.4%; OR 0.84, 95% CI 0.72-0.98; P = .022). However, rates of percutaneous coronary intervention alone were similar in both groups (9.9% in NH versus 9.1% in community-dwelling; OR 1.10, 95% CI 0.93-1.30; P = .276). Mean length of stay was also similar in both groups (5.68 ± 5.40 days in NH versus 5.69 ± 4.98 days in community-dwelling, P = .974).

CONCLUSION: Compared with their community-dwelling counterparts, older NH patients are less likely to receive reperfusion therapy for STEMI and have higher in-hospital mortality.

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