Predicting 6-Month Mortality for Older Adults Hospitalized With Acute Myocardial Infarction: A Cohort Study.

Abstract:

Background:Older adults with acute myocardial infarction (AMI) have higher prevalence of functional impairments, including deficits in cognition, strength, and sensory domains, than their younger counterparts. Objective:To develop and evaluate the prognostic utility of a risk model for 6-month post-AMI mortality in older adults that incorporates information about functional impairments. Design:Prospective cohort study. (ClinicalTrials.gov: NCT01755052). Setting:94 hospitals throughout the United States. Participants:3006 persons aged 75 years or older who were hospitalized with AMI and discharged alive. Measurements:Functional impairments were assessed during hospitalization via direct measurement (cognition, mobility, muscle strength) or self-report (vision, hearing). Clinical variables associated with mortality in prior risk models were ascertained by chart review. Seventy-two candidate variables were selected for inclusion, and backward selection and Bayesian model averaging were used to derive (n = 2004 participants) and validate (n = 1002 participants) a model for 6-month mortality. Results:Participants' mean age was 81.5 years, 44.4% were women, and 10.5% were nonwhite. There were 266 deaths (8.8%) within 6 months. The final risk model included 15 variables, 4 of which were not included in prior risk models: hearing impairment, mobility impairment, weight loss, and lower patient-reported health status. The model was well calibrated (Hosmer-Lemeshow P > 0.05) and showed good discrimination (area under the curve for the validation cohort = 0.84). Adding functional impairments significantly improved model performance, as evidenced by category-free net reclassification improvement indices of 0.21 (P = 0.008) for hearing impairment and 0.26 (P < 0.001) for mobility impairment. Limitation:The model was not externally validated. Conclusion:A newly developed model for 6-month post-AMI mortality in older adults was well calibrated and had good discriminatory ability. This model may be useful in decision making at hospital discharge. Primary Funding Source:National Heart, Lung, and Blood Institute of the National Institutes of Health.

journal_name

Ann Intern Med

authors

Dodson JA,Hajduk AM,Geda M,Krumholz HM,Murphy TE,Tsang S,Tinetti ME,Nanna MG,McNamara R,Gill TM,Chaudhry SI

doi

10.7326/M19-0974

subject

Has Abstract

pub_date

2020-01-07 00:00:00

pages

12-21

issue

1

eissn

0003-4819

issn

1539-3704

pii

2757402

journal_volume

172

pub_type

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