LONDON, 14 September (
A multicenter team, led by Jerome Allison from the University of Alabama at Birmingham, collected data on 114,411 elderly patients who were diagnosed with acute MI on admission to hospital. Overall, 439 major teaching hospitals, 455 minor teaching hospitals and 3,467 non-teaching hospitals were included in the analysis. Among the three types of hospital, respectively, administration rates for aspirin were 91.2%, 86.4% and 81.4% (p<0.001); for ACE inhibitors, 63.7%, 60.0% and 58.0% (p<0.001); for beta-blockers, 48.8%, 40.3% and 36.4% (p<0.001); and for reperfusion therapy, 55.5%, 58.9% and 55.2% (p=0.29). Differences in unadjusted 30-day, 60-day, 90-day and two-year mortality among hospitals were significant at p<0.001, with a gradient of increasing mortality from major teaching to minor teaching to non-teaching hospitals. Mortality differences, however, were attenuated by adjustment for patient characteristics and were almost eliminated by additional adjustment for receipt of therapy.