John A. Dodson, MD, MPH; Alexandra M. Hajduk, PhD, MPH; Mary Geda, RN, MSN; Harlan M. Krumholz, MD; Terrence E. Murphy, PhD; Sui Tsang, MS; Mary E. Tinetti, MD; Michael G. Nanna, MD; Richard McNamara, MD; Thomas M. Gill, MD; Sarwat I. Chaudhry, MD
Disclaimer: The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Grant Support: This research was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) (R01HL115295). This work was conducted at the Yale Program on Aging/Claude D. Pepper Older Americans Independence Center (P30AG021342). The project described in the article used REDCap (Research Electronic Data Capture), which is supported by the National Center for Advancing Translational Sciences of the NIH through grant UL1 TR00000. Dr. Dodson is the recipient of Patient-Oriented Research Career Development Award K23-AG052463 from the National Institute on Aging of the NIH. Dr. Hajduk was supported by a training grant from the National Institute on Aging (T32-AG19134). Dr. Nanna is supported by NIH training grant T32-HL069749-15. Dr. Gill is the recipient of an Academic Leadership Award (K07-AG043587) from the National Institute on Aging.
Disclosures: Dr. Krumholz reports personal fees from UnitedHealth, IBM Watson Health, Element Science, Aetna, Arnold & Porter, Ben C. Martin Law Firm, Facebook, and the National Center for Cardiovascular Diseases, Beijing; ownership (with spouse) of Hugo; contracts from the Centers for Medicare & Medicaid Services; and grants from Medtronic, the U.S. Food and Drug Administration, Johnson & Johnson, and the Shenzhen Center for Health Information outside the submitted work. Dr. Chaudhry reports personal fees from the CVS Caremark Clinical Program for the state of Connecticut outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-0974.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement:Study protocol: See Supplement 2. Statistical code and data set: Available from Dr. Chaudhry (e-mail, Sarwat.firstname.lastname@example.org).
Corresponding Author: Sarwat I. Chaudhry, MD, Yale University School of Medicine, 367 Cedar Street, Room 416, New Haven, CT 06510; e-mail, Sarwat.email@example.com.
Current Author Addresses: Dr. Dodson: New York University School of Medicine, 227 East 30th Street, TRB 851, New York, NY 10016.
Drs. Hajduk, Murphy, Tinetti, Gill, and Chaudhry; Ms. Geda; and Ms. Tsang: Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510.
Dr. Krumholz: Yale University – Center for Outcomes Research & Evaluation, 1 Church Street, Suite 200, New Haven, CT 06510.
Dr. McNamara: SHMG Cardiovascular Medicine, 2900 Bradford Street NE, MC229, Grand Rapids, MI 49525-6427.
Dr. Nanna: Duke Clinical Research Institute, 200 Morris Street, Durham, NC 27701.
Author Contributions: Conception and design: J.A. Dodson, T.E. Murphy, M.G. Nanna, T.M. Gill, S.I. Chaudhry.
Analysis and interpretation of the data: J.A. Dodson, A.M. Hajduk, H.M. Krumholz, T.E. Murphy, S. Tsang, M.G. Nanna, S.I. Chaudhry.
Drafting of the article: J.A. Dodson, A.M. Hajduk, T.E. Murphy, M.G. Nanna, S.I. Chaudhry.
Critical revision of the article for important intellectual content: J.A. Dodson, A.M. Hajduk, M. Geda, H.M. Krumholz, T.E. Murphy, M.E. Tinetti, M.G. Nanna, T.M. Gill, S.I. Chaudhry.
Final approval of the article: J.A. Dodson, A.M. Hajduk, M. Geda, H.M. Krumholz, T.E. Murphy, S. Tsang, M.E. Tinetti, M.G. Nanna, R. McNamara, T.M. Gill, S.I. Chaudhry.
Provision of study materials or patients: S.I. Chaudhry.
Statistical expertise: A.M. Hajduk, T.E. Murphy.
Obtaining of funding: T.M. Gill, S.I. Chaudhry.
Administrative, technical, or logistic support: M. Geda, S. Tsang, R. McNamara, S.I. Chaudhry.
Collection and assembly of data: M. Geda, S. Tsang, M.G. Nanna, R. McNamara, S.I. Chaudhry.
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.
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.
Prospective cohort study. (ClinicalTrials.gov: NCT01755052).
94 hospitals throughout the United States.
3006 persons aged 75 years or older who were hospitalized with AMI and discharged alive.
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.
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.
The model was not externally validated.
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.
National Heart, Lung, and Blood Institute of the National Institutes of Health.
Dodson JA, Hajduk AM, Geda M, et al. Predicting 6-Month Mortality for Older Adults Hospitalized With Acute Myocardial Infarction: A Cohort Study. Ann Intern Med. 2020;172:12–21. [Epub ahead of print 10 December 2019]. doi: https://doi.org/10.7326/M19-0974
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Published: Ann Intern Med. 2020;172(1):12-21.
Published at www.annals.org on 10 December 2019
Acute Coronary Syndromes, Cardiology, Coronary Heart Disease, Emergency Medicine, Geriatric Medicine.
Copyright © 2020 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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