TY - JOUR
T1 - Risk model for decline in activities of daily living among older adults hospitalized with acute myocardial infarction
T2 - The SILVER-AMI study
AU - Hajduk, Alexandra M.
AU - Dodson, John A.
AU - Murphy, Terrence E.
AU - Tsang, Sui
AU - Geda, Mary
AU - Ouellet, Gregory M.
AU - Gill, Thomas M.
AU - Brush, John E.
AU - Chaudhry, Sarwat I.
N1 - Funding Information:
This research was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health (R01HL115295). This work was conducted at the Yale Program on Aging/Claude D. Pepper Older Americans Independence Center (P30AG021342). Dr Hajduk was supported by a training grant from the National Institute on Aging (T32AG019134) and a career development award from the American Heart Association (17MCPRP33670631). Dr Dodson was supported by a Patient Oriented Career Development Award (K23AG052463) from the National Institute on Aging. Dr Gill is the recipient of an Academic Leadership Award (K07AG043587) from the National Institute on Aging.
Publisher Copyright:
© 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2020/10/6
Y1 - 2020/10/6
N2 - BACKGROUND: Functional decline (ie, a decrement in ability to perform everyday activities necessary to live independently) is common after acute myocardial infarction (AMI) and associated with poor long-term outcomes; yet, we do not have a tool to identify older AMI survivors at risk for this important patient-centered outcome. METHODS AND RESULTS: We used data from the prospective SILVER-AMI (Comprehensive Evaluation of Risk Factors in Older Patients With Acute Myocardial Infarction) study of 3041 patients with AMI, aged ≥75 years, recruited from 94 US hospitals. Participants were assessed during hospitalization and at 6 months to collect data on demographics, geriatric impairments, psychosocial factors, and activities of daily living. Clinical variables were abstracted from the medical record. Functional decline was defined as a decrement in ability to independently perform essential activities of daily living (ie, bathing, dressing, transferring, and ambulation) from baseline to 6 months postdischarge. The mean age of the sample was 82±5 years; 57% were men, 90% were White, and 13% reported activity of daily living decline at 6 months postdischarge. The model identified older age, longer hospital stay, mobility impairment during hospitalization, preadmission physical activity, and depression as risk factors for decline. Revascularization during AMI hospitalization and ability to walk a quarter mile before AMI were associated with decreased risk. Model discrimination (c=0.78) and calibration were good. CONCLUSIONS: We identified a parsimonious model that predicts risk of activity of daily living decline among older patients with AMI. This tool may aid in identifying older patients with AMI who may benefit from restorative therapies to optimize function after AMI.
AB - BACKGROUND: Functional decline (ie, a decrement in ability to perform everyday activities necessary to live independently) is common after acute myocardial infarction (AMI) and associated with poor long-term outcomes; yet, we do not have a tool to identify older AMI survivors at risk for this important patient-centered outcome. METHODS AND RESULTS: We used data from the prospective SILVER-AMI (Comprehensive Evaluation of Risk Factors in Older Patients With Acute Myocardial Infarction) study of 3041 patients with AMI, aged ≥75 years, recruited from 94 US hospitals. Participants were assessed during hospitalization and at 6 months to collect data on demographics, geriatric impairments, psychosocial factors, and activities of daily living. Clinical variables were abstracted from the medical record. Functional decline was defined as a decrement in ability to independently perform essential activities of daily living (ie, bathing, dressing, transferring, and ambulation) from baseline to 6 months postdischarge. The mean age of the sample was 82±5 years; 57% were men, 90% were White, and 13% reported activity of daily living decline at 6 months postdischarge. The model identified older age, longer hospital stay, mobility impairment during hospitalization, preadmission physical activity, and depression as risk factors for decline. Revascularization during AMI hospitalization and ability to walk a quarter mile before AMI were associated with decreased risk. Model discrimination (c=0.78) and calibration were good. CONCLUSIONS: We identified a parsimonious model that predicts risk of activity of daily living decline among older patients with AMI. This tool may aid in identifying older patients with AMI who may benefit from restorative therapies to optimize function after AMI.
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U2 - 10.1161/JAHA.119.015555
DO - 10.1161/JAHA.119.015555
M3 - Article
C2 - 33000681
AN - SCOPUS:85092677525
SN - 2047-9980
VL - 9
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 19
M1 - e015555
ER -