Key result
A risk model incorporating functional impairments showed good discrimination for 6-month post-AMI mortality in older adults (AUC 0.84) and significantly improved classification over prior models.
Why the study?
Older adults with acute myocardial infarction frequently have functional impairments, prompting the development and evaluation of a 6-month mortality risk model incorporating these impairments.
Cohort (n=3,006)
Yes
Effect estimate: AUC 0.84
Incorporating functional impairments such as hearing and mobility into risk models significantly improves the prediction of 6-month mortality in older adults surviving an acute myocardial infarction.
May aid post-AMI risk stratification in older adults; leaves open whether integration improves outcomes.
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 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. 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. Primary Funding Source: National Heart, Lung, and Blood Institute of the National Institutes of Health.
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Dodson et al. (2019) conducted a cohort in Acute myocardial infarction (AMI) (n=3,006). Functional impairments (hearing, mobility, weight loss, health status) vs. Prior risk models without functional impairments was evaluated on 6-month mortality (AUC 0.84). A risk model incorporating functional impairments showed good discrimination for 6-month post-AMI mortality in older adults (AUC 0.84) and significantly improved classification over prior models.
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