Quality of care for acute myocardial infarction in elderly patients with alcohol-related diagnoses

Older Americans with alcohol problems do not get worse treatment than their sober peers when they are hospitalized for a heart attack, according to new research on Medicare patients across the country.

Alcoholic patients were less likely than sober patients to receive beta-blocker drugs when they were discharged from the hospital, but there were no other significant treatment differences between the two groups. The study is published in the latest issue of the journal Alcoholism: Clinical and Experimental Research.

"Alcohol-related diagnoses are not a barrier to receiving most quality of care measures in elderly patients hospitalized" for heart attack, David Fiellin, M.D., of Yale University School of Medicine and colleagues conclude.

The encouraging finding "speaks to the fact that there have been significant efforts across the board, in medicine in general, to monitor the provision of quality care," Fiellin said.

However, the researchers also note that the "overall provision of quality of care indicators was low," when measured across all patients.

Fiellin and colleagues analyzed data for 155,026 Medicare patients age 65 and older admitted to a hospital with a heart attack. Only 1,284 of these patients also had an alcohol-related diagnosis on their medical records.

The researchers then compared the care that the patients received with seven quality guidelines for heart attack treatment, including the use of beta-blocker and ACE inhibitor drugs, aspirin, angioplasty and advice to quit smoking.

With the exception of beta-blockers prescribed upon release from the hospital, patients with an alcohol diagnosis fared no worse than their peers in terms of getting guideline care.

Fiellin and colleagues began their study with the thought that elderly adults diagnosed with an alcohol abuse problem could be a "vulnerable population" that might receive substandard treatment in the hospitals.

"I think that concern was that, as we know, patients who have mental health diagnoses can experience some level of stigma when they enter the health care system," Fiellin said.

Earlier studies by some of Fiellin's co-authors found that patients with mental disorders, including substance abuse, were less likely to get heart procedures such as certain types of bypass and angioplasty surgeries.

Age may also play an unwelcome discriminating factor in what kind of care certain patients receive, as Canadian researchers showed earlier this year. Shaohua Wang, M.D., a clinical professor of cardiac surgery at the University of Alberta, said that more than half of hospitals in North America who offer transplants use age as one of their criteria to screen out individuals for transplant.

However, the Alberta study showed that patients aged 60 and older did just as well as younger patients after receiving a heart transplant.

"There are many factors involved in determining who is and who isn't an appropriate candidate for a heart transplant, but this study clearly shows that age should not be one of those factors," Wang said.