Resolving inequalities in care? Reduced mortality in the elderly after acute coronary syndromes. The Myocardial Ischaemia National Audit Project 2003-2010

To examine age-dependent in-hospital mortality for hospitalization with acute coronary syndromes (ACS) in England and Wales. Mixed-effects regression analysis using data from 616 011 ACS events at 255 hospitals as recorded in the Myocardial Ischemia National Audit Project (MINAP) 20032010; 102 415 (16.7) patients were aged 55 years and 72 721 (11.9) epsilon 85 years. Patients epsilon 85 years with ST-elevation myocardial infarction (STEMI) were less likely to receive emergency reperfusion therapy than those 55 years (RR 0.27, 95 CI: 0.250.28). Older patients had greater lengths of stay (P 0.001) and higher in-hospital mortality (P 0.001). For STEMI and non-ST-elevation myocardial infarction (NSTEMI), there were reductions in in-hospital mortality from 2003 to 2010 across all age groups including the very elderly. For STEMI epsilon 85 years, in-hospital mortality reduced from 30.1 in 2003 to 19.4 in 2010 (RR 0.54, 95 CI: 0.380.75, P 0.001), and for NSTEMI epsilon 85 years, from 31.5 in 2003 to 20.4 in 2010 (RR 0.56, 95 CI: 0.420.73, P 0.001). Findings were upheld after multi-level adjustment (base 2003): male STEMI 2010 OR 0.60, 95 CI: 0.480.75; female STEMI 2010 OR 0.55, 95 CI: 0.420.71; male NSTEMI OR 0.50, 95 CI: 0.420.60; female NSTEMI OR 0.49, 95 CI: 0.400.59. For patients hospitalized with ACS in England and Wales, there have been substantial reductions in in-hospital mortality rates from 2003 to 2010 across all age groups. The temporal improvements in mortality were similar for sex and type of acute myocardial infarction. Age-dependent inequalities in the management of ACS were apparent.