TY - JOUR
T1 - Thirty-day readmission risk model for older adults hospitalized with acute myocardial infarction
T2 - The silver-Ami study
AU - Dodson, John A.
AU - Hajduk, Alexandra M.
AU - Murphy, Terrence E.
AU - Geda, Mary
AU - Krumholz, Harlan M.
AU - Tsang, Sui
AU - Nanna, Michael G.
AU - Tinetti, Mary E.
AU - Goldstein, David
AU - Forman, Daniel E.
AU - Alexander, Karen P.
AU - Gill, Thomas M.
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). The project described used REDCap, which is supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (NIH), through grant UL1 TR00000. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr Dodson is supported by a Patient Oriented Career Development Award (K23 AG052463) from the National Institute of Aging. Dr Hajduk was supported by NIA training grant T32 AG019134. Dr Gill is the recipient of an Academic Leadership Award (K07AG043587) from the National Institute on Aging. Dr Nanna is supported by an NIH training grant 5T32HL069749-15.
Publisher Copyright:
© 2019 American Heart Association, Inc.
PY - 2019/5/1
Y1 - 2019/5/1
N2 - Background: Early readmissions among older adults hospitalized for acute myocardial infarction (AMI) are costly and difficult to predict. Aging-related functional impairments may inform risk prediction but are unavailable in most studies. Our objective was to, therefore, develop and validate an AMI readmission risk model for older patients who considered functional impairments and was suitable for use before hospital discharge. Methods and Results: SILVER-AMI (Comprehensive Evaluation of Risk in Older Adults with AMI) is a prospective cohort study of 3006 patients of age ≥75 years hospitalized with AMI at 94 US hospitals. Participants underwent in-hospital assessment of functional impairments including cognition, vision, hearing, and mobility. Other variables plausibly associated with readmissions were also collected. The outcome was all-cause readmission at 30 days. We used backward selection and Bayesian model averaging to derive (N=2004) a risk model that was subsequently validated (N=1002). Mean age was 81.5 years, 44.4% were women, and 10.5% were nonwhite. Within 30 days, 547 participants (18.2%) were readmitted. Readmitted participants were older, had more comorbidities, and had a higher prevalence of functional impairments, including activities of daily living disability (17.0% versus 13.0%; P=0.013) and impaired functional mobility (72.5% versus 53.6%; P<0.001). The final risk model included 8 variables: functional mobility, ejection fraction, chronic obstructive pulmonary disease, arrhythmia, acute kidney injury, first diastolic blood pressure, P2Y12 inhibitor use, and general health status. Functional mobility was the only functional impairment variable retained but was the strongest predictor. The model was well calibrated (Hosmer-Lemeshow P value >0.05) with moderate discrimination (C statistics: 0.65 derivation cohort and 0.63 validation cohort). Functional mobility significantly improved performance of the risk model (net reclassification improvement index =20%; P<0.001). Conclusions: In our final risk model, functional mobility, previously not included in readmission risk models, was the strongest predictor of 30-day readmission among older adults after AMI. The modest discrimination indicates that much of the variability in readmission risk among this population remains unexplained by patient-level factors. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01755052.
AB - Background: Early readmissions among older adults hospitalized for acute myocardial infarction (AMI) are costly and difficult to predict. Aging-related functional impairments may inform risk prediction but are unavailable in most studies. Our objective was to, therefore, develop and validate an AMI readmission risk model for older patients who considered functional impairments and was suitable for use before hospital discharge. Methods and Results: SILVER-AMI (Comprehensive Evaluation of Risk in Older Adults with AMI) is a prospective cohort study of 3006 patients of age ≥75 years hospitalized with AMI at 94 US hospitals. Participants underwent in-hospital assessment of functional impairments including cognition, vision, hearing, and mobility. Other variables plausibly associated with readmissions were also collected. The outcome was all-cause readmission at 30 days. We used backward selection and Bayesian model averaging to derive (N=2004) a risk model that was subsequently validated (N=1002). Mean age was 81.5 years, 44.4% were women, and 10.5% were nonwhite. Within 30 days, 547 participants (18.2%) were readmitted. Readmitted participants were older, had more comorbidities, and had a higher prevalence of functional impairments, including activities of daily living disability (17.0% versus 13.0%; P=0.013) and impaired functional mobility (72.5% versus 53.6%; P<0.001). The final risk model included 8 variables: functional mobility, ejection fraction, chronic obstructive pulmonary disease, arrhythmia, acute kidney injury, first diastolic blood pressure, P2Y12 inhibitor use, and general health status. Functional mobility was the only functional impairment variable retained but was the strongest predictor. The model was well calibrated (Hosmer-Lemeshow P value >0.05) with moderate discrimination (C statistics: 0.65 derivation cohort and 0.63 validation cohort). Functional mobility significantly improved performance of the risk model (net reclassification improvement index =20%; P<0.001). Conclusions: In our final risk model, functional mobility, previously not included in readmission risk models, was the strongest predictor of 30-day readmission among older adults after AMI. The modest discrimination indicates that much of the variability in readmission risk among this population remains unexplained by patient-level factors. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01755052.
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U2 - 10.1161/CIRCOUTCOMES.118.005320
DO - 10.1161/CIRCOUTCOMES.118.005320
M3 - Article
C2 - 31010300
AN - SCOPUS:85065116617
SN - 1941-7713
VL - 12
JO - Circulation: Cardiovascular Quality and Outcomes
JF - Circulation: Cardiovascular Quality and Outcomes
IS - 5
M1 - e005320
ER -