TY - JOUR
T1 - Predicting 6-month mortality for older adults hospitalized with acute myocardial infarction
AU - Dodson, John A.
AU - Hajduk, Alexandra M.
AU - Geda, Mary
AU - Krumholz, Harlan M.
AU - Murphy, Terrence E.
AU - Tsang, Sui
AU - Tinetti, Mary E.
AU - Nanna, Michael G.
AU - McNamara, Richard
AU - Gill, Thomas M.
AU - Chaudhry, Sarwat I.
N1 - Funding Information:
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.
Funding Information:
Disclosures: Dr. Krumholz reports personal fees from United-Health, 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 Shen-zhen 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/ConflictOfInterest Forms.do?msNum=M19-0974.
Funding Information:
The National Heart, Lung, and Blood Institute of the National Institutes of Health supported this study but had no role in its design, conduct, or reporting.
Publisher Copyright:
© 2019 American College of Physicians.
PY - 2020/1/7
Y1 - 2020/1/7
N2 - 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.
AB - 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.
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U2 - 10.7326/M19-0974
DO - 10.7326/M19-0974
M3 - Article
C2 - 31816630
AN - SCOPUS:85077928395
SN - 0003-4819
VL - 172
SP - 12
EP - 21
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 1
ER -