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Predicting 6-Month Mortality for Older Adults Hospitalized With AMI
Study Questions:
What is the prognostic utility of a risk model for 6-month post–acute myocardial infarction (AMI) mortality in older adults that incorporates information about functional impairment?
Methods:
The investigators conducted a prospective cohort study in 94 hospitals throughout the United States and enrolled 3,006 persons aged ≥75 years 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 = 2,004 participants) and validate (n = 1,002 participants) a model for 6-month mortality. Discrimination and calibration of the final model were evaluated in the derivation and validation cohorts using the c-statistic and the Hosmer–Lemeshow goodness-of-fit statistic, respectively.
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, four 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.
Conclusions:
The authors concluded that a newly developed model for 6-month post-AMI mortality in older adults was well calibrated and had good discriminatory ability and may be useful in decision making at hospital discharge.
Perspective:
This study reports on a novel risk model for mortality within 6 months of hospitalization for AMI in patients aged ≥75 years that considered 15 risk factors including traditional risk factors, functional impairments, and other conditions common with aging. Functional impairments, not used in prior models enhanced the predictive ability of this model and with use of a Web-based calculator, may be used to inform prognostication at the time of hospital discharge.
Clinical Topics: Acute Coronary Syndromes, Cardiovascular Care Team, Geriatric Cardiology, Prevention
Keywords: Acute Coronary Syndrome, Cognition, Decision Making, Geriatrics, Health Status, Hearing Loss, Hearing Tests, Muscle Strength, Myocardial Infarction, Patient Discharge, Risk Factors, Secondary Prevention, Weight Loss
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