OBJECTIVES: To determine the pattern and predictors of use of acute pharmacological treatment (anti-platelet agents and beta-blockers) given in the emergency department (ED) to older adults with acute myocardial infarction (AMI). METHODS: Data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) ED component from years 1992 to 2010 were used for the cross-sectional study. Patients were included if they had an admission diagnosis of AMI (ICD-9-CM code 410.xx) and were ≥55 years. Drug users were divided into 4 groups: anti-platelet agents only, beta-blockers only, anti-platelet agents & beta-blockers, and non-users. Survey logistic regression was used to examine the trend in the use of drugs across the years and whether age predicted drug use. All the visits were weighted to obtain national estimates. All the analysis were carried out in SAS 9.3. RESULTS: A total of 1771 visit (weighted: 6.1 million visits) by patients were selected for this study. Almost 54% [95% CI: 51.7% to 57.1%] of our population are females with a mean age of 72 (SE= 0.33) years. This population is 87% white [95% CI: 84.9% to 89.1%] and 94% non-Hispanic [95% CI: 91.8% to 95.3%]. Both anti-platelet agents and beta-blockers showed to have a positive trend across the years (OR= 1.09 [95% CI: 1.07 to 1.19] and OR= 1.16 [95% CI: 1.13 to 1.19], respectively). Age was a significant predictor of anti-platelet agents use (OR= 0.76 [95% CI: 0.62 to 0.93]), older adults (≥65) were less likely to receive an anti-platelet agent than younger adults; however, age was not considered to be a significant predictor of beta-blocker use. CONCLUSIONS: This study displayed a positive pattern across the years in the use of acute pharmacological treatment given for older AMI patients. It also suggested that older adults were less likely to be treated acutely with anti-platelet agents.