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June 4, 1997

Coronary Thrombolysis for the ElderlyIs Clinical Practice Really Lagging Behind Evidence of Benefit?

Author Affiliations

From the Meyers Primary Care Institute, University of Massachusetts Medical Center and the Fallon Healthcare System, and the Department of Medicine, University of Massachusetts Medical School, Worcester, Mass.

JAMA. 1997;277(21):1723-1724. doi:10.1001/jama.1997.03540450079040

Given the low survival experience of older persons following acute myocardial infarction,1 claims that thrombolytic therapy is underused in this patient population are particularly disconcerting. Regional, national, and multinational populationbased studies of age-related patterns of thrombolytic use have provided support for these assertions.2,3 It is unclear, however, to what extent these patterns of care reflect age bias in the use of an effective therapy vs the appropriately cautious use of a treatment that carries inherent risks and for which only a limited number of elderly patients with acute myocardial infarction are eligible. In this issue of The JOURNAL, Krumholz et al4 provide evidence suggesting that the answer to this question probably lies somewhere between these 2 extremes.

See also p 1683.

In their study, the authors carefully analyzed data from the medical records of 3093 Medicare beneficiaries, aged 65 years and older, admitted to all acute care