Consultative geriatric assessment for ambulatory patients: a randomized trial in a health maintenance organization

Article Abstract:

The National Institutes of Health Consensus Development Conference on Assessment has concluded that health benefits arising from the comprehensive assessment of geriatric patients are most evident in rehabilitation and inpatient environments. Since survey data have suggested that the majority of assessment services are directed at ambulatory patients, it is important to acquire reliable evaluations of the effectiveness of these services. Six hundred elderly patients were selected from an 80,000 patient health maintenance organization (HMO). Patients were included in the study if they were either over 74 years old, or between 70 and 74 years old and of fair or worse health. These patients were randomly assigned to receive either comprehensive geriatric assessment (185 patients), consultation with a second-opinion internist (210 patients) or standard HMO care practice (205 patients). At the end of one year, there were no differences among the groups in mortality, placement into nursing homes, or hospitalization. The trial was designed so that a 10 percent improvement over the standard HMO care control group was likely to be detected, and therefore the provision of geriatric assessment seems not to provide any substantial health benefits for the elderly patients in the HMO setting. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Surveys, Hospital patients, Ambulatory medical care, Ambulatory care

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Acute myocardial infarction in the Medicare population: process of care and clinical outcomes

Article Abstract:

Elderly individuals who have a heart attack may have a poorer prognosis than younger individuals. A review of Medicare records on 218,427 heart attack patients over the age of 65 found that 26% died within 30 days, 40% within one year and 47% within two years. Those aged 85 and over had even higher mortality rates; 38% died within 30 days. Mortality rates were not significantly different between women and men, although women had a slightly lower mortality rate after two years. Whites had a slightly poorer prognosis than blacks at 30 days, but by two years, mortality rates were the same between the races. Only 7% of the patients had another heart attack within a year of the first. Younger patients, men and whites were more likely to undergo coronary angiography, bypass surgery and angioplasty. Treatment of heart attacks is based on the results of research, but many studies exclude elderly patients.

Patient outcomes, Mortality, Prognosis

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Use of cardiac procedures and outcomes in elderly patients with myocardial infarction in the United States and Canada

Article Abstract:

The more frequent use of cardiac procedures following a heart attack in the US versus Canada does not appear to reduce mortality rates. Researchers compared the use of procedures such as angiography, angioplasty and bypass surgery in 224,258 elderly US residents and 9,444 elderly Canadian residents. All had suffered a heart attack in 1991. US patients were much more likely to receive a cardiac procedure within 30 days of their heart attack compared to Canadian patients. Although 30-day mortality rates were slightly lower in the US, at one year, the rates were identical.

Care and treatment, Demographic aspects, Coronary artery bypass, Transluminal angioplasty, Balloon angioplasty

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