TABLE 2.
Safety and effectiveness events by age group in the pre‐ and post‐implementation cohorts
| Older adult (≥65 years) | Middle‐aged (46–64 years) | Young (21–45 years) | Interaction | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Age X Implementation Cohort (Baseline: Older adult) | |||||||||||
| Pre | Post | aOR a | Pre | Post | aOR a | Pre | Post | aOR a | Young * Implementation Cohort | Middle‐aged * Implementation Cohort | |
| N = 978 (%) | N = 1303 (%) | N = 1730 (%) | N = 2132 (%) | N = 1005 (%) | N = 1326 (%) | p‐value | p‐value | ||||
| Safety | |||||||||||
| Index | |||||||||||
| Death b | 4 (0.4) | 9 (0.7) | 1.69 (0.52–5.52) | 2 (0.1) | 5 (0.2) | 2.03 (0.39–10.48) | 1 (0.1) | 1 (0.1) | 0.76 (0.05–12.2) | 0.60 | 0.86 |
| MI | 85 (8.7) | 140 (10.7) | 1.42 (1.05–1.92) | 98 (5.7) | 138 (6.5) | 1.38 (1.04–1.84) | 28 (2.8) | 36 (2.7) | 1.05 (0.60–1.83) | 0.25 | 0.63 |
| Revascularization b | 41 (4.2) | 68 (5.2) | 1.26 (0.85–1.87) | 71 (4.1) | 75 (3.5) | 0.85 (0.61–1.19) | 7 (0.7) | 11 (0.8) | 1.19 (0.46–3.09) | 0.92 | 0.14 |
| Death + MI | 88 (9.0) | 147 (11.3) | 1.45 (1.08–1.95) | 100 (5.8) | 141 (6.6) | 1.38 (1.04–1.84) | 29 (2.9) | 37 (2.8) | 1.03 (0.60–1.77) | 0.21 | 0.57 |
| MACE (Death + MI + Revasc) | 100 (10.2) | 164 (12.6) | 1.43 (1.08–1.90) | 126 (7.3) | 153 (7.2) | 1.14 (0.87–1.49) | 31 (3.1) | 38 (2.9) | 1.00 (0.58–1.70) | 0.18 | 0.15 |
| 30‐Day follow‐up | |||||||||||
| Death b | 25 (2.6) | 20 (1.5) | 0.59 (0.33–1.08) | 9 (0.5) | 3 (0.1) | 0.27 (0.07–1.00) | 3 (0.3) | 1 (0.1) | 0.25 (0.03–2.43) | 0.47 | 0.28 |
| MI c | 7 (0.7) | 12 (0.9) | 1.32 (0.52–3.36) | 10 (0.6) | 11 (0.5) | 0.90 (0.38–2.13) | 1 (0.1) | 6 (0.5) | 4.59 (0.55–38.23) | 0.29 | 0.56 |
| Revascularization d | 7 (0.7) | 18 (1.4) | 2.00 (0.83–4.83) | 16 (0.9) | 15 (0.7) | 0.77 (0.38–1.57) | 2 (0.2) | 5 (0.4) | 1.90 (0.37–9.84) | 0.96 | 0.10 |
| Death + MI c | 29 (3.0) | 31 (2.4) | 0.85 (0.51–1.43) | 18 (1.0) | 13 (0.6) | 0.60 (0.29–1.24) | 3 (0.3) | 7 (0.5) | 1.85 (0.48–7.23) | 0.29 | 0.46 |
| MACE (Death + MI + Revasc) c | 35 (3.6) | 32 (3.3) | 0.99 (0.63–1.57) | 13 (0.6) | 24 (1.1) | 0.72 (0.41–1.25) | 5 (0.5) | 10 (0.8) | 1.52 (0.51–4.49) | 0.44 | 0.36 |
| 30‐Day (Index + Follow‐up) | |||||||||||
| Death b | 29 (3.0) | 29 (2.2) | 0.75 (0.44–1.26) | 11 (0.6) | 8 (0.4) | 0.59 (0.24–1.47) | 4 (0.4) | 2 (0.2) | 0.38 (0.07–2.07) | 0.46 | 0.66 |
| MI | 88 (9.0) | 144 (11.1) | 1.42 (1.06–1.91) | 106 (6.1) | 143 (6.7) | 1.32 (1.00–1.75) | 29 (2.9) | 37 (2.8) | 1.04 (0.60–1.80) | 0.23 | 0.47 |
| Revascularization d | 48 (4.9) | 85 (6.5) | 1.38 (0.96–1.99) | 86 (5.0) | 89 (4.2) | 0.84 (0.62–1.14) | 9 (0.9) | 16 (1.2) | 1.36 (0.60–3.08) | 0.97 | 0.04 |
| Death + MI | 110 (11.2) | 166 (12.7) | 1.31 (0.99–1.71) | 116 (6.7) | 148 (6.9) | 1.23 (0.94–1.61) | 32 (3.2) | 39 (2.9) | 0.96 (0.56–1.62) | 0.27 | 0.52 |
| MACE (Death + MI + Revasc) | 124 (12.7) | 189 (14.5) | 1.33 (1.02–1.72) | 144 (8.3) | 164 (7.7) | 1.06 (0.82–1.37) | 35 (3.5) | 42 (3.2) | 0.95 (0.57–1.58) | 0.22 | 0.13 |
| Effectiveness | |||||||||||
| Index | |||||||||||
| Hospitalization | 737 (75.4) | 1012 (77.7) | 1.20 (0.96–1.48) | 1102 (63.7) | 1208 (56.7) | 0.78 (0.67–0.90) | 329 (39.0) | 362 (27.3) | 0.58 (0.47–0.70) | <0.0001 | 0.0002 |
| Objective Cardiac Testing | 290 (29.7) | 444 (34.1) | 1.29 (1.07–1.56) | 636 (36.8) | 697 (32.7) | 0.86 (0.74–0.99) | 219 (21.8) | 166 (12.5) | 0.50 (0.40–0.64) | <0.001 | <0.001 |
| Early Discharge | 220 (22.5) | 268 (20.6) | 0.84 (0.67–1.05) | 580 (33.5) | 860 (40.3) | 1.28 (1.10–1.49) | 590 (58.7) | 918 (69.2) | 1.61 (1.33–1.95) | <0.001 | 0.0004 |
| 30‐Day (Index ± Follow‐up) | |||||||||||
| Hospitalization | 752 (76.9) | 1035 (79.4) | 1.25 (1.00–1.55) | 1127 (65.1) | 1235 (57.9) | 0.77 (0.66–0.89) | 409 (40.7) | 379 (28.6) | 0.57 (0.47–0.69) | <0.001 | <0.001 |
| Objective Cardiac Testing | 330 (33.7) | 487 (37.4) | 1.25 (1.04–1.51) | 699 (40.4) | 771 (36.2) | 0.87 (0.75–1.00) | 252 (25.1) | 204 (15.4) | 0.52 (0.42–0.66) | <0.001 | 0.0003 |
Note: Bold font denotes findings of statistical significance.
Abbreviations: aOR, adjusted odds ratio; MI, myocardial infarction.
a
Models adjusted for sex, race, ethnicity, BMI, ED location, insurance status, smoking, history of CAD, diabetes, hyperlipidemia, hypertension, and the presence of chest pain versus other symptoms concerning for acute coronary syndrome.
b
Index death, index revascularization, and 30‐day death are unadjusted given the small number of events.
c
Adjusted for sex, race, and ED location given small number of events.
d
30‐Day revascularization is only adjusted for sex given the small number of events.