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Is coronary-care-unit admission restricted for elderly patients? A multicenter study.

C Fleming, R B D'Agostino and H P Selker

Center for Cardiovascular Health Services Research and Study Design, New England Medical Center Hospitals, Boston, MA.

BACKGROUND. To investigate whether elderly patients are more likely to experience restricted access to high technology medical care, we examined the impact of age on the likelihood of coronary care unit (CCU) admission for patients with acute myocardial infarction. METHODS. As part of a prospective investigation of emergency room triage for patients with suspected cardiac ischemia, we studied 4223 patients presenting to six hospitals. Because CCU admission is the accepted standard of care for acute infarction, we defined nonadmission to the CCU as a restriction of access to care. We used a logistic regression model to control for gender, hospital, and CCU occupancy at the time of admission and examined the relationship between age and CCU nonadmission. RESULTS. Patients 75 years or older with acute myocardial infarction were 2.5 times more likely not to be admitted to the CCU than younger patients (RR 2.5, 95% CI 1.64, 3.85). Coronary unit admission was restricted even when the physician's admitting diagnosis was "myocardial infarction" (RR 7.1, 95% CI 2.1, 25.0) or "rule-out myocardial infarction" (RR 1.5, 95% CI 1.1, 2.1). Observed differences in clinical presentation or severity of illness between older and younger patients did not account for these findings. CONCLUSION. Our findings suggest that physicians may intentionally restrict access to coronary care for elderly patients with acute myocardial infarction.

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