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ARTICLE |

Exclusion of the Elderly and Women From Coronary Trials: Title and subTitle BreakIs Their Quality of Care Compromised? FREE

Nanette K. Wenger, MD
[+] Author Affiliations

Reprint requests to the Department of Medicine, Division of Cardiology, Emory University School of Medicine, 69 E Butler St, SE, Atlanta, GA 30303 (Dr Wenger).


JAMA. 1992;268(11):1460-1461. doi:10.1001/jama.1992.03490110098038
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Increasing numbers of elderly individuals have changed not only the profile of the US population, but also the demography of cardiovascular disease. Currently, 13% of the population is older than age 65 years; this percentage is expected to increase to 21%, or 35 million people, by the year 2030. The "oldest old," or those 85 years old or older, number 2.7 million individuals; they constitute the most rapidly growing subgroup among the elderly, with a projected sixfold increase by the year 2030.1 Although studies to guide the therapeutic management of this rapidly growing portion of our population should warrant high priority, the age-based exclusions of contemporary clinical trials limit this process.2 Coronary heart disease increasingly is a disease of and cause of death among the aging population. The majority of US patients with clinical manifestations of coronary heart disease are older than 65 years; more than half of

REFERENCES

Dawson DA, Adams PF.  Current estimates from the National Health Interview Survey, United States, 1986. Vital Health Stat 10 . 1987;; No. (164) .
Gurwitz JH, Col NF, Avorn J.  The exclusion of the elderly and women from clinical trials in acute myocardial infarction. JAMA . 1992;;268:1417-1422.
Maynard C, Althouse R, Cerqueira M, Olsufka M, Kennedy JW.  Underutilization of thrombolytic therapy in eligible women with acute myocardial infarction. Am J Cardiol . 1991;;68:529-530.
Wenger NK, Furberg CD, Pitt E. Coronary Heart Disease in the Elderly . New York, NY: Elsevier Science Publishing; 1986;.
Thompson RC, Holmes DR Jr, Gersh BJ, Mock MB, Bailey KR.  Percutaneous transluminal coronary angioplasty in the elderly: early and long term results. J Am Coll Cardiol . 1991;;17:1245-1250.
Freeman WK, Schaff HV, O'Brien PC, Orszulak TA, Naessens JM, Tajik AJ.  Cardiac surgery in the octogenarian: perioperative outcome and clinical follow-up. J Am Coll Cardiol . 1991;;18:29-35.
Jecker NS.  Age-based rationing and women. JAMA . 1991;;266:3012-3015.
American Heart Association. 1992 Heart and Stroke Facts . Dallas, Tex: American Heart Association; 1991;.
Wenger NK.  Gender, coronary artery disease, and coronary bypass surgery. Ann Intern Med . 1990;;112:557-558.
Ayanian JZ, Epstein AM.  Differences in the use of procedures between men and women hospitalized for coronary heart disease. N Engl J Med . 1991;;325:221-225.
Steingart RM, Packer M, Hamm P, et al.  Sex differences in the management of coronary artery disease. N Engl J Med . 1991;;325:226-230.
Council on Ethical and Judicial Affairs, American Medical Association.  Gender disparities in clinical decision making. JAMA . 1991;;266:559-562.

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Dawson DA, Adams PF.  Current estimates from the National Health Interview Survey, United States, 1986. Vital Health Stat 10 . 1987;; No. (164) .
Gurwitz JH, Col NF, Avorn J.  The exclusion of the elderly and women from clinical trials in acute myocardial infarction. JAMA . 1992;;268:1417-1422.
Maynard C, Althouse R, Cerqueira M, Olsufka M, Kennedy JW.  Underutilization of thrombolytic therapy in eligible women with acute myocardial infarction. Am J Cardiol . 1991;;68:529-530.
Wenger NK, Furberg CD, Pitt E. Coronary Heart Disease in the Elderly . New York, NY: Elsevier Science Publishing; 1986;.
Thompson RC, Holmes DR Jr, Gersh BJ, Mock MB, Bailey KR.  Percutaneous transluminal coronary angioplasty in the elderly: early and long term results. J Am Coll Cardiol . 1991;;17:1245-1250.
Freeman WK, Schaff HV, O'Brien PC, Orszulak TA, Naessens JM, Tajik AJ.  Cardiac surgery in the octogenarian: perioperative outcome and clinical follow-up. J Am Coll Cardiol . 1991;;18:29-35.
Jecker NS.  Age-based rationing and women. JAMA . 1991;;266:3012-3015.
American Heart Association. 1992 Heart and Stroke Facts . Dallas, Tex: American Heart Association; 1991;.
Wenger NK.  Gender, coronary artery disease, and coronary bypass surgery. Ann Intern Med . 1990;;112:557-558.
Ayanian JZ, Epstein AM.  Differences in the use of procedures between men and women hospitalized for coronary heart disease. N Engl J Med . 1991;;325:221-225.
Steingart RM, Packer M, Hamm P, et al.  Sex differences in the management of coronary artery disease. N Engl J Med . 1991;;325:226-230.
Council on Ethical and Judicial Affairs, American Medical Association.  Gender disparities in clinical decision making. JAMA . 1991;;266:559-562.
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