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.

中文翻译：

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预测因急性心肌梗死住院的老年人 6 个月死亡率：一项队列研究。


背景 患有急性心肌梗死 (AMI) 的老年人比年轻人更容易出现功能障碍，包括认知、力量和感觉领域的缺陷。目的 开发并评估老年人 AMI 后 6 个月死亡率风险模型的预后效用，该模型包含有关功能障碍的信息。设计前瞻性队列研究。 （ClinicalTrials.gov：NCT01755052）。在全美设有 94 家医院。参与者 3006 名 75 岁或以上因 AMI 住院并活着出院的人。测量 住院期间通过直接测量（认知、活动能力、肌肉力量）或自我报告（视力、听力）评估功能障碍。通过图表审查确定了先前风险模型中与死亡率相关的临床变量。选择纳入 72 个候选变量，并使用向后选择和贝叶斯模型平均来推导（n = 2004 名参与者）和验证（n = 1002 名参与者）6 个月死亡率模型。结果 参与者的平均年龄为 81.5 岁，其中 44.4% 为女性，10.5% 为非白人。 6 个月内有 266 人死亡（8.8%）。最终的风险模型包含 15 个变量，其中 4 个变量未包含在之前的风险模型中：听力障碍、行动障碍、体重减轻和患者报告的健康状况较低。该模型经过良好校准 (Hosmer-Lemeshow P > 0.05)，并显示出良好的辨别力（验证队列的曲线下面积 = 0.84）。添加功能障碍可显着提高模型性能，听力障碍的无类别净重分类改善指数为 0.21 (P = 0.008)，听力障碍为 0.26 (P < 0.001）针对行动障碍。限制 该模型未经外部验证。结论 新开发的老年人 AMI 后 6 个月死亡率模型校准良好，具有良好的区分能力。该模型可能有助于出院时的决策。主要资金来源 美国国立卫生研究院国家心脏、肺和血液研究所。