***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background — The use of antithrombotic medications after ischemic stroke is recommended for deep vein thrombosis prophylaxis and secondary stroke prevention . We assessed the rate of receipt of these therapies among eligible ischemic stroke patients age ≥65 years and determined the effects of age and other patient characteristics on treatment . Methods and Results — The analysis included Medicare fee-for-service beneficiaries discharged with ischemic stroke ( ICD 433.x1 , 434.x1 , 436 ) r and omly selected for inclusion in the Medicare Health Care Quality Improvement Program 's National Stroke Project 1998 to 1999 , 2000 to 2001 . Patients discharged from nonacute facilities , transferred , or terminally ill were excluded . Receipt of in-hospital pharmacological deep vein thrombosis prophylaxis , antiplatelet medication , anticoagulants for atrial fibrillation , and antithrombotic medications at discharge were assessed in eligible patients , stratified by age ( 65 to 74 , 75 to 84 , and 85 + years ) . Descriptive models identified characteristics associated with treatment . Among 31 554 patients , 14.9 % of those eligible received pharmacological deep vein thrombosis prophylaxis , 83.9 % antiplatelet drugs , 82.8 % anticoagulants for atrial fibrillation , and 74.2 % were discharged on an antithrombotic medication . Rates of treatment decreased with age and were lowest for patients ages 85 years or older . Admission from a skilled nursing facility and functional dependence were associated with lower treatment rates . Conclusions — There was substantial underutilization  of antithrombotic therapies  among elderly ischemic stroke patients , particularly among the very elderly , those admitted from skilled nursing facilities , and patients with functional dependence . The reasons for low use of antithrombotic therapies , including the apparent underutilization of deep vein thrombosis prophylaxis in otherwise eligible patients , require further investigation BACKGROUND Recent guidelines have acknowledged that thrombolysis decreases mortality from acute myocardial infa rct ion ( AMI ) independently of age . The purpose of this study was to determine the age-related rates of thrombolytic administration and in-hospital mortality and the variables related to the use of thrombolytic therapy for patients with AMI . METHODS A prospect i ve cohort analysis involved a registry of 44 acute care Quebec hospitals that enrolled 3741 patients with AMI between January 1995 and May 1996 . The main outcomes of interest were crude and adjusted age-related in-hospital mortality rates and rates of use of thrombolytic therapy .  RESULTS In-hospital mortality rates increased dramatically with age from 2.1 % in patients with AMI who were less than 55 years of age to 26.3 % in those who were 85 years of age or older . Overall , 35.8 % of the patients received  thrombolysis .  There was a pronounced inverse gradient in the use of  thrombolysis  with age , ranging from 46.2 % in the youngest age group ( < 55 years ) to 9.5 % in the oldest group ( > or = 85 years ) . After adjustment for potential confounders , the older patients remained significantly less likely to receive  thrombolytic therapy .  Compared with patients who were less than 55 years of age , the odds ratio of receiving  thrombolytic therapy  was 0.68 ( 95 % confidence interval [ CI ] 0.52 - 0.89 ) for patients aged 65 - 74 years , 0.48 ( 95 % CI 0.35 - 0.65 ) for patients aged 75 - 84 years and 0.13 ( 95 % CI 0.06 - 0.26 ) for patients aged 85 years or more . Other variables related to thrombolytic therapy were diabetes ( odds ratio [ OR ] 0.77 , 95 % CI 0.59 - 1.00 ) , cerebrovascular disease ( OR 0.46 , 95 % CI 0.30 - 0.72 ) , angina ( OR 0.73 , 95 % CI 0.56 - 0.95 ) , typical chest pain ( OR 2.56 , 95 % CI 1.88 - 3.47 ) ; ST elevation ( OR 8.93 , 95 % CI 7.24 - 11.00 ) , Q wave MI ( OR 5.26 , 95 % CI 4.20 - 6.60 ) and increased length of time between onset of symptoms and arrival at hospital . INTERPRETATION Age is an important independent predictor of in-hospital mortality and lower thrombolytic use following AMI . Other studies are required to further evaluate the appropriateness of thrombolytic therapy for elderly patients BACKGROUND Mortality  among patients admitted to hospital after out-of-hospital cardiac arrest ( OHCA ) is high . Based on recent scientific evidence with a main goal of improving survival , we introduced and implemented a st and ardised post resuscitation protocol focusing on vital organ function including therapeutic hypothermia , percutaneous coronary intervention ( PCI ) , control of haemodynamics , blood glucose , ventilation and seizures . METHODS All patients with OHCA of cardiac aetiology admitted to the ICU from September 2003 to May 2005 ( intervention period ) were included in a prospect i ve , observational study and compared to controls from February 1996 to February 1998 . RESULTS In the control period 15/58 ( 26 % ) survived to hospital discharge with a favourable neurological outcome versus 34 of 61 ( 56 % ) in the intervention period ( OR 3.61 , CI 1.66 - 7.84 , p=0.001 ) . All survivors with a favourable neurological outcome in both groups were still alive 1 year after discharge . Two patients from the control period were revascularised with thrombolytics versus 30 ( 49 % ) receiving PCI treatment in the intervention period ( 47 patients ( 77 % ) underwent cardiac angiography ) .  Therapeutic hypothermia  was not used in the control period , but 40 of 52 ( 77 % ) comatose patients received this treatment in the intervention period . CONCLUSIONS Discharge rate from hospital , neurological outcome and 1-year survival improved after st and ardisation of post resuscitation care . Based on a multivariate logistic analysis , hospital treatment in the intervention period was the most important independent predictor of survival CONTEXT R and omized trials provide robust evidence for the impact of pharmacological and interventional treatments in patients with ST-segment elevation and non-ST-segment elevation acute coronary syndromes ( NSTE ACS ) , but whether this translates to changes in clinical practice is unknown . OBJECTIVE To determine whether changes in hospital management of patients with ST-segment elevation myocardial infa rct ion ( STEMI ) and NSTE ACS are associated with improvements in clinical outcome . DESIGN , SETTING , AND PATIENTS In the Global Registry of Acute Coronary Events ( GRACE ) , a multinational cohort study , 44 372 patients with an ACS were enrolled and followed up in 113 hospitals in 14 countries between July 1 , 1999 , and December 31 , 2006 . MAIN OUTCOME MEASURES Temporal trends in the use of evidence -based pharmacological and interventional therapies ; patient outcomes ( death , congestive heart failure , pulmonary edema , cardiogenic shock , stroke , myocardial infa rct ion ) . RESULTS Use of pharmacological medications increased over the study period ( beta-blockers , statins , angiotensin-converting enzyme inhibitors , thienopyridines with or without percutaneous coronary intervention [ PCI ] , glycoprotein IIb/IIIa inhibitors , low-molecular-weight heparin ; all P<.001 ) . Pharmacological reperfusion declined in patients with STEMI by -22 percentage points ( 95 % confidence interval [ CI ] , -27 to -17 ) , whereas primary PCI increased by 37 percentage points ( 95 % CI , 33 - 41 ) . In patients with non-STEMI , rates of PCI increased markedly by 18 percentage points ( 95 % CI , 15 - 20 ) . Rates of congestive heart failure and pulmonary edema declined in both population s : STEMI , -9 percentage points ( 95 % CI , -12 to -6 ) and NSTE ACS , -6.9 percentage points ( 95 % CI , -8.4 to -4.7 ) . In patients with STEMI , hospital deaths decreased by 18 percentage points ( 95 % CI , -5.3 to -1.9 ) and cardiogenic shock by -24 percentage points ( 95 % CI , -4.3 to -0.5 ) . Risk-adjusted hospital deaths declined -0.7 percentage points ( 95 % CI , -1.7 to 0.3 ) in NSTE ACS patients . Six-month follow-up rates declined among STEMI patients : stroke by -0.8 percentage points ( 95 % CI , -1.7 to 0.1 ) and myocardial infa rct ion by -2.8 percentage points ( 95 % CI , -6.4 to 0.9 ) . In NSTE ACS , 6-month death declined -1.6 percentage points ( 95 % CI , -3.0 to -0.1 ) and stroke by 0.7 percentage points ( 95 % CI , -1.4 to 0.1 ) . CONCLUSIONS In this multinational observational study , improvements in the management of patients with ACS were associated with significant reductions in the rates of new heart failure and mortality and in rates of stroke and mycoardial infa rct ion at 6 months Introduction Persistent coma is a common finding after cardiac arrest and has profound ethical and economic implication s. Evidence suggests that therapeutic hypothermia improves neurological outcome in these patients . In this analysis , we investigate whether therapeutic hypothermia influences the length of intensive care unit ( ICU ) stay and ventilator time in patients surviving out-of-hospital cardiac arrest . Methods A prospect i ve observational study with historical controls was conducted at our medical ICU . Fifty-two consecutive patients ( median age 62.6 years , 43 males , 34 ventricular fibrillation ) su bmi tted to therapeutic hypothermia after out-of-hospital cardiac arrest were included . They were compared with a  historical cohort ( n = 74 , median age 63.8 years , 53 males , 43 ventricular fibrillation ) treated in the era prior to hypothermia treatment .  All patients received the same st and ard of care . Neurological outcome was assessed using the Pittsburgh cerebral performance category ( CPC ) score . Univariate analyses and multiple regression models were used . Results In survivors , therapeutic hypothermia and baseline disease severity ( Acute Physiology and Chronic Health Evaluation II [ APACHE II ] score ) were both found to significantly influence ICU stay and ventilator time ( all P < 0.01 ) . ICU stay was shorter in survivors receiving therapeutic hypothermia ( median 14 days [ interquartile range ( IQR ) 8 to 26 ] versus 21 days [ IQR 15 to 30 ] in the control group ; P = 0.017 ) . ICU length of stay and time on ventilator were prolonged in patients with CPC 3 or 4 compared with patients with CPC 1 or 2 ( P = 0.003 and P = 0.034 , respectively ) . Kaplan-Meier analysis showed improved probability for 1-year survival in the hypothermia group compared with the controls ( log-rank test P = 0.013 ) . Conclusion Therapeutic hypothermia was found to significantly shorten ICU stay and time of mechanical ventilation in survivors after out-of-hospital cardiac arrest . Moreover , profound improvements in both neurological outcome and 1-year survival were observed Background —Acute coronary occlusion is the leading cause of cardiac arrest . Because of limited data , the indications and timing of coronary angiography and angioplasty in patients with out-of-hospital cardiac arrest are controversial . Using data from the Parisian Region Out of hospital Cardiac ArresT prospect i ve registry , we performed an analysis to assess the effect of an invasive strategy on hospital survival . Methods and Results —Between January 2003 and December 2008 , 714 patients with out-of-hospital cardiac arrest were referred to a tertiary center in Paris , France . In 435 patients with no obvious extracardiac cause of arrest , an  immediate coronary angiogram was performed at admission followed , if indicated , by coronary angioplasty . At least 1 significant coronary artery lesion was found in 304 ( 70 % ) patients , in 128 ( 96 % ) of 134 patients with ST-segment elevation on the ECG performed after the return of spontaneous circulation , and in 176 ( 58 % ) of 301 patients without ST-segment elevation . The hospital survival rate was 40 % . Multivariable analysis showed successful coronary  angioplasty to be an independent predictive factor of survival , regardless of the postresuscitation ECG pattern ( odds ratio , 2.06 ; 
    Output:
    
Discussion The findings obtained from this systematic review should inform whether disparity exists in the provision of post-arrest care for the elderly ( ≥ 65 years old ) with OHCA or not .
Addressing this problem has a potential to substantially increase the number of > 65-year-old , long-term survivors .
The results of our review might also point to the gaps in the published literature that specifically examines disparity in provision of care for this population .