Predicting 6-month mortality for older adults hospitalized with acute myocardial infarction

Research output: Contribution to journalArticle

Authors

  • John A. Dodson
  • Alexandra M. Hajduk
  • Mary Geda
  • Harlan M. Krumholz
  • Terrence E. Murphy
  • Sui Tsang
  • Mary E. Tinetti
  • Michael G. Nanna
  • Richard McNamara
  • Thomas M. Gill
  • Sarwat I. Chaudhry

External Institution(s)

  • Yale University
  • Duke University
  • SHMG Cardiovascular Medicine

Details

Original languageEnglish (US)
Pages (from-to)12-21
Number of pages10
JournalAnnals of internal medicine
Volume172
Issue number1
StatusPublished - Jan 7 2020
Peer-reviewedYes

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 patientreported 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.

Citation formats

APA

Dodson, J. A., Hajduk, A. M., Geda, M., Krumholz, H. M., Murphy, T. E., Tsang, S., ... Chaudhry, S. I. (2020). Predicting 6-month mortality for older adults hospitalized with acute myocardial infarction. Annals of internal medicine, 172(1), 12-21. https://doi.org/10.7326/M19-0974

Harvard

Dodson, JA, Hajduk, AM, Geda, M, Krumholz, HM, Murphy, TE, Tsang, S, Tinetti, ME, Nanna, MG, McNamara, R, Gill, TM & Chaudhry, SI 2020, 'Predicting 6-month mortality for older adults hospitalized with acute myocardial infarction', Annals of internal medicine, vol. 172, no. 1, pp. 12-21. https://doi.org/10.7326/M19-0974