The prognostic significance of age in patients with acute myocardial infarction (AMI) is well established in the literature. The efficacy of pharmacologic and invasive procedures in AMI have been based primarily on younger patients and observational studies suggest a lower use of these interventions in the elderly. The overall aim of the research is to understand whether older patients are treated differently and, if so, whether ageism or other factors play a role in the (1) diagnosis of AMI, (2) delay in diagnosis and treatment of AMI, (3) utilization of pharmacologic therapies and interventional procedures, (4) geographic variation in AMI care, and (5) outcomes of AMI patients. These objectives will be addressed using the Minnesota Heart Survey (MHS, R01 HL65755), which includes a population-based database of over 5000 abstracted medical records of AMI patients hospitalized in 2001-2002 in the Minneapolis-St. Paul metropolitan area. The investigator will conduct a series of focus group interviews with health care professionals at selected MHS hospitals to explore the factors that enter into the decision-making process of elderly patients. He will then develop a multi-faceted intervention directed at quality of care improvement in the elderly. This intervention will be pilot-tested in the K08 project to assess its feasibility as the basis of an R01 grant. The applicant, with the support of an advisory committee representing both epidemiology and geriatrics, has developed a focused 5-year career development plan with 75% guaranteed protected time for research. The advanced course curriculum in the fields of epidemiology, biostatistics, and health services research will provide the applicant with a Masters in Public Health in Epidemiology. The applicant will achieve an in-depth training in geriatric medicine through the combination of a board-review course, seminars, consultation services, and scientific meetings. The K08 training will provide the necessary skills to permit the applicant to compete successfully for an R01 grant.
