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Cockburn J, Kemp T, Ludman P, Kinnaird T, Johnson T, Curzen N, Robinson D, Mamas M, de Belder A, Hildick-Smith D. Percutaneous coronary intervention in octogenarians: A risk scoring system to predict 30-day outcomes in the elderly. Catheter Cardiovasc Interv 2020; 98:1300-1307. [PMID: 33283484 DOI: 10.1002/ccd.29406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/26/2020] [Accepted: 11/15/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Octogenarians are a high-risk group presenting for percutaneous coronary intervention (PCI). We aimed to create a 30-day mortality risk model for octogenarians presenting with both acute coronary syndrome (ACS) and chronic stable angina (CSA), using comprehensive mandatory UK data submissions to the UK National database. BACKGROUND Octogenarians are a high-risk group presenting for percutaneous coronary intervention, and decisions on whether or not to undertake intervention in this cohort can be challenging. The increasing number of octogenarians in the general population means they represent an important high-risk subgroup of patients. METHODS The data group consisted of 425,897 PCI procedures undertaken in the UK between 2008 and 2012 during which time there was comprehensive data linkage to mortality via the Office of National Statistics. Of these procedures, 44,221 (10.4%) were in patients aged ≥80. These comprised the model group. Logistic regression was used to create a predictive score which ultimately consisted of the following weightings: age 80-89 (n = 1); age > 90 (n = 2); unstable angina/non-ST-elevation myocardial infraction (NSTEMI) (n = 1); STEMI (n = 2); creatinine >200 mmol/L (n = 1); preprocedural ventilation (n = 1); left ventricular ejection fraction <30% (n = 1); cardiogenic shock (n = 2). Multiple imputation was used to account for missing data. RESULTS The patient cohort was divided into a derivation (n = 22,072) and a validation dataset (n = 22,071). Receiver operating characteristic analyses were used to derive the area-under-the-curve to assess properties of the score. The scoring system generated an AUC 0.83, (95% CI 0.80-0.85) suggesting high sensitivity and specificity. Scores of 1-4 were associated with good survival but scores ≥5 were associated with an estimated likelihood of death within 30 days of ≥40%. CONCLUSIONS This octogenarian risk score maybe a useful tool to determine the chance of a successful outcome in elderly patients presenting for PCI.
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Affiliation(s)
- James Cockburn
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Tiffany Kemp
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Peter Ludman
- Queen Elizabeth Hospital NHS Trust, Birmingham, UK
| | | | | | - Nick Curzen
- University Hospital Southampton, Southampton, UK
| | - Derek Robinson
- Department of Mathematics, Sussex University, Brighton, UK
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Manchester, UK
| | - Adam de Belder
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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Hajduk AM, Dodson JA, Murphy TE, Tsang S, Geda M, Ouellet GM, Gill TM, Brush JE, Chaudhry SI. Risk Model for Decline in Activities of Daily Living Among Older Adults Hospitalized With Acute Myocardial Infarction: The SILVER-AMI Study. J Am Heart Assoc 2020; 9:e015555. [PMID: 33000681 PMCID: PMC7792390 DOI: 10.1161/jaha.119.015555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background Functional decline (ie, a decrement in ability to perform everyday activities necessary to live independently) is common after acute myocardial infarction (AMI) and associated with poor long-term outcomes; yet, we do not have a tool to identify older AMI survivors at risk for this important patient-centered outcome. Methods and Results We used data from the prospective SILVER-AMI (Comprehensive Evaluation of Risk Factors in Older Patients With Acute Myocardial Infarction) study of 3041 patients with AMI, aged ≥75 years, recruited from 94 US hospitals. Participants were assessed during hospitalization and at 6 months to collect data on demographics, geriatric impairments, psychosocial factors, and activities of daily living. Clinical variables were abstracted from the medical record. Functional decline was defined as a decrement in ability to independently perform essential activities of daily living (ie, bathing, dressing, transferring, and ambulation) from baseline to 6 months postdischarge. The mean age of the sample was 82±5 years; 57% were men, 90% were White, and 13% reported activity of daily living decline at 6 months postdischarge. The model identified older age, longer hospital stay, mobility impairment during hospitalization, preadmission physical activity, and depression as risk factors for decline. Revascularization during AMI hospitalization and ability to walk a quarter mile before AMI were associated with decreased risk. Model discrimination (c=0.78) and calibration were good. Conclusions We identified a parsimonious model that predicts risk of activity of daily living decline among older patients with AMI. This tool may aid in identifying older patients with AMI who may benefit from restorative therapies to optimize function after AMI.
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Affiliation(s)
| | - John A. Dodson
- Leon H. Charney Division of CardiologyDepartment of MedicineNew York University School of MedicineNew YorkNY
- Division of Healthcare Delivery ScienceDepartment of Population HealthNew York University School of MedicineNew YorkNY
| | | | - Sui Tsang
- Department of Internal MedicineYale School of MedicineNew HavenCT
| | - Mary Geda
- Department of Internal MedicineYale School of MedicineNew HavenCT
| | | | - Thomas M. Gill
- Department of Internal MedicineYale School of MedicineNew HavenCT
| | - John E. Brush
- Sentara Healthcare and Eastern Virginia Medical SchoolNorfolkVA
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Mori M, Djulbegovic M, Hajduk AM, Holland ML, Krumholz HM, Chaudhry SI. Changes in Functional Status and Health-Related Quality of Life in Older Adults After Surgical, Interventional, or Medical Management of Acute Myocardial Infarction. Semin Thorac Cardiovasc Surg 2020; 33:72-81. [PMID: 32439546 DOI: 10.1053/j.semtcvs.2020.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 02/07/2023]
Abstract
Functional status and health-related quality of life (HRQoL) are important outcomes, particularly among older patients. However, data on such patient-centered outcomes after cardiac surgery are limited. We evaluated the incidence and predictors of decline in functional status and HRQoL among older patients hospitalized for acute myocardial infarction (AMI). Participants were age 75 years or older hospitalized for AMI at 94 US sites. We examined decline in functional status (defined as decline in 1 or more activities of daily living, ADLs), as well as mental (MCS) and physical component scales (PCS) of the SF-12 to assess HRQoL (5-point decline or greater in each scale) between 1 month prior to the hospitalization and 6 months after. Multivariable model compared the risk of decline after coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI) and medical management. Among 3041 patients (1708 PCI, 362 CABG, and 971 medical management), 1525 (50.2%) experienced decline in 1 or more domain: 633 (20.8%) declined in ADLs, 786 (25.9%) declined in the MCS, and 1078 (35.5%) declined in the PCS. The unadjusted incidence of ADL decline was the lowest among patients who underwent CABG (n = 50, 13.8%) compared with PCI (n = 271, 15.9%) or medical management (n = 312, 32.1%). Patients who underwent CABG and PCI had lower adjusted risk of decline in functional and HRQoL compared with those who received medical therapy. The risks after CABG and PCI were not significantly different. Over half of older patients significantly declined in function or HRQoL after AMI. Compared with medical management, risk of decline was lower in those who underwent revascularization.
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Affiliation(s)
- Makoto Mori
- Section of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
| | - Mia Djulbegovic
- National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut; Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Alexandra M Hajduk
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Sarwat I Chaudhry
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
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Dodson JA, Hajduk AM, Murphy TE, Geda M, Krumholz HM, Tsang S, Nanna MG, Tinetti ME, Goldstein D, Forman DE, Alexander KP, Gill TM, Chaudhry SI. Thirty-Day Readmission Risk Model for Older Adults Hospitalized With Acute Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2020; 12:e005320. [PMID: 31010300 DOI: 10.1161/circoutcomes.118.005320] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
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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Affiliation(s)
- John A Dodson
- Leon H. Charney Division of Cardiology, Department of Medicine; Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine (J.A.D.)
| | - Alexandra M Hajduk
- Leon H. Charney Division of Cardiology, Department of Medicine; Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine (J.A.D.)
| | - Terrence E Murphy
- Leon H. Charney Division of Cardiology, Department of Medicine; Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine (J.A.D.)
| | - Mary Geda
- Leon H. Charney Division of Cardiology, Department of Medicine; Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine (J.A.D.)
| | - Harlan M Krumholz
- Leon H. Charney Division of Cardiology, Department of Medicine; Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine (J.A.D.)
| | - Sui Tsang
- Leon H. Charney Division of Cardiology, Department of Medicine; Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine (J.A.D.)
| | - Michael G Nanna
- Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.G.N., K.P.A.)
| | - Mary E Tinetti
- Leon H. Charney Division of Cardiology, Department of Medicine; Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine (J.A.D.)
| | - David Goldstein
- Leon H. Charney Division of Cardiology, Department of Medicine; Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine (J.A.D.)
| | - Daniel E Forman
- Section of Geriatric Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, PA (D.E.F.)
| | - Karen P Alexander
- Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.G.N., K.P.A.)
| | - Thomas M Gill
- Leon H. Charney Division of Cardiology, Department of Medicine; Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine (J.A.D.)
| | - Sarwat I Chaudhry
- Leon H. Charney Division of Cardiology, Department of Medicine; Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine (J.A.D.)
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Hermans MPJ, Eindhoven DC, van Winden LAM, de Grooth GJ, Blauw GJ, Muller M, Schalij MJ. Frailty score for elderly patients is associated with short-term clinical outcomes in patients with ST-segment elevated myocardial infarction treated with primary percutaneous coronary intervention. Neth Heart J 2019; 27:127-133. [PMID: 30771094 PMCID: PMC6393578 DOI: 10.1007/s12471-019-1240-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Consistent with the aging population in the Western world, there is a growing number of elderly patients with ST-segment elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI) is the recommended reperfusion strategy in elderly patients; risk models to determine which of these patients are prone to have poor clinical outcomes are, however, essential. The purpose of this study was to assess the association between frailty and short-term mortality and PCI-related serious adverse events (SAE) in elderly patients. METHODS All STEMI patients (aged ≥70 years) treated with primary PCI in 2013-2015 at the Leiden University Medical Centre were assessed. The Safety Management Programme (VMS) score was used to identify frail elderly patients. The primary endpoint was 30-day all-cause mortality; the secondary endpoint included 30-day clinical death, target vessel failure, major bleeding, contrast induced kidney insufficiency and stroke. RESULTS A total of 206 patients were included (79 ± 6.4 years, 119 [58%] male). The VMS score was ≥1 in 28% of all cases. Primary and secondary endpoint rates were 5 and 23% respectively. VMS score ≥1 was an independent predictor for both 30-day mortality (odds ratio [OR] 9.6 [95% confidence interval, CI 1.6-56.9] p-value = 0.013) and 30-day SAE (OR 2.9 [95% CI 1.1-7.9] p-value = 0.038). CONCLUSIONS VMS score for frailty is independently associated with short-term mortality and PCI-related SAE in elderly patients with STEMI treated with primary PCI. These results suggest that frailty in elderly patients is an important feature to measure and to be taken into account when developing risk models.
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Affiliation(s)
- M P J Hermans
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - D C Eindhoven
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - L A M van Winden
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - G J de Grooth
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - G J Blauw
- Department of Internal/Geriatric Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - M Muller
- Department of Internal/Geriatric Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - M J Schalij
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
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Smedegaard L, Kragholm K, Numé AK, Charlot MG, Gislason GH, Hansen PR. Nursing home admission after myocardial infarction in the elderly: A nationwide cohort study. PLoS One 2018; 13:e0202177. [PMID: 30110366 PMCID: PMC6093673 DOI: 10.1371/journal.pone.0202177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 07/30/2018] [Indexed: 12/19/2022] Open
Abstract
Background Data on nursing home admission after myocardial infarction (MI) in the elderly are scarce. We investigated nursing home admission within 6 months and 2 years after MI including predictors for nursing home admission in a nationwide cohort of elderly patients. Methods Using Danish nationwide registries, we identified all subjects 65 years or older residing at home who were discharged following first-time MI in the period 2008–2015. We determined sex- and age-stratified incidence rates per 1000 person years (IRs) and incidence rate ratios (IRRs) of nursing home admissions using Poisson regression models compared to the Danish population 65 years or older with no prior MI. Poisson regression models were also applied to identify predictors of nursing home admission. Results The 26,539 patients who were discharged after MI had a median age of 76 (quartile 1-quartile 3: 70–83) years. The IRs of nursing home admission after MI increased with increasing age and for 80-84-year-old women IRs after 6 months and 2 years were 113.9 and 62.9, respectively, compared to 29.4 for women of the same age with no prior MI. The IRs for 80-84-year-old men after MI were 56.0 and 36.2, respectively, compared to 24.3 for men of the same age with no prior MI. In adjusted analyses the 6 months and 2 years IRRs for 80-84-year-old subjects were 2.56 (95% CI 2.11–3.10) and 1.41 (95% CI 1.22–1.65) for women and 1.74 (95% CI 1.34–2.25) and 1.05 (95% CI 0.88–1.26) for men, respectively. Predictors were advanced age, dementia, home care, Parkinson’s disease, cerebrovascular disease, living alone, depression, and arrhythmia. Conclusion In elderly patients discharged following first-time MI, the risk of subsequent nursing home admission within 6 months was 2-fold higher compared to an age-stratified population with no prior MI. After 2 years this risk remained higher in women.
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Affiliation(s)
- Laerke Smedegaard
- Herlev & Gentofte University Hospital, Department of Cardiology, Hellerup, Denmark
- * E-mail:
| | - Kristian Kragholm
- Aalborg University Hospital, Department of Clinical Epidemiology and Biostatistics, Aalborg, Denmark
| | - Anna-Karin Numé
- Herlev & Gentofte University Hospital, Department of Cardiology, Hellerup, Denmark
| | - Mette Gitz Charlot
- Herlev & Gentofte University Hospital, Department of Cardiology, Hellerup, Denmark
| | - Gunnar Hilmar Gislason
- Herlev & Gentofte University Hospital, Department of Cardiology, Hellerup, Denmark
- The Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Faculty of Health & Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
| | - Peter Riis Hansen
- Herlev & Gentofte University Hospital, Department of Cardiology, Hellerup, Denmark
- Faculty of Health & Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Duscha BD, Piner LW, Patel MP, Craig KP, Brady M, McGarrah RW, Chen C, Kraus WE. Effects of a 12-week mHealth program on peak VO 2 and physical activity patterns after completing cardiac rehabilitation: A randomized controlled trial. Am Heart J 2018; 199:105-114. [PMID: 29754647 DOI: 10.1016/j.ahj.2018.02.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/02/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Site-based cardiac rehabilitation (CR) provides supervised exercise, education and motivation for patients. Graduates of CR have improved exercise tolerance. However, when participation in CR ceases, adherence to regular physical activity often declines, consequently leading to worsening risk factors and clinical events. Therefore, the purpose of this pilot study was to evaluate if a mHealth program could sustain the fitness and physical activity levels gained during CR. METHODS AND RESULTS A 12-week mHealth program was implemented using physical activity trackers and health coaching. Twenty-five patients were randomized into mHealth or usual care after completing CR. The combination of a 4.7±13.8% increase in the mHealth and a 8.5±11.5% decrease in the usual care group resulted in a difference between groups (P≤.05) for absolute peak VO2. Usual care decreased the amount of moderate-low physical activity minutes per week (117±78 vs 50±53; P<.05) as well as moderate-high (111±87 vs 65±64; P<.05). mHealth increased moderate-high physical activity (138±113 vs 159±156; NS). The divergent changes between mHealth and usual care in moderate-high physical activity minutes/week resulted in a difference between groups (21±103 vs - 46±36; P<.05). CONCLUSIONS A 12-week mHealth program of physical activity trackers and health coaching following CR graduation can sustain the gains in peak VO2 and physical activity achieved by site-based CR.
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Affiliation(s)
- Brian D Duscha
- Duke University School of Medicine, Division of Cardiology, Durham, NC and Duke Molecular Physiology Institute.
| | - Lucy W Piner
- Duke University School of Medicine, Division of Cardiology, Durham, NC and Duke Molecular Physiology Institute
| | - Mahesh P Patel
- Duke University School of Medicine, Division of Cardiology, Durham, NC and Duke Molecular Physiology Institute
| | - Karen P Craig
- Duke University School of Medicine, Division of Cardiology, Durham, NC and Duke Molecular Physiology Institute
| | | | - Robert W McGarrah
- Duke University School of Medicine, Division of Cardiology, Durham, NC and Duke Molecular Physiology Institute
| | | | - William E Kraus
- Duke University School of Medicine, Division of Cardiology, Durham, NC and Duke Molecular Physiology Institute
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Trends in the treatment and outcomes of elderly patients with acute coronary syndrome: Results from the CZECH registries. COR ET VASA 2018. [DOI: 10.1016/j.crvasa.2017.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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9
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Puymirat E, Aissaoui N, Cayla G, Lafont A, Riant E, Mennuni M, Saint-Jean O, Blanchard D, Jourdain P, Elbaz M, Henry P, Bataille V, Drouet E, Mulak G, Schiele F, Ferrières J, Simon T, Danchin N. Changes in One-Year Mortality in Elderly Patients Admitted with Acute Myocardial Infarction in Relation with Early Management. Am J Med 2017; 130:555-563. [PMID: 28065766 DOI: 10.1016/j.amjmed.2016.12.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 12/03/2016] [Accepted: 12/05/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Elderly patients are underrepresented in acute myocardial infarction trials. Our aim was to determine whether, in elderly patients, changes in management in the past 15 years are associated with improved 1-year mortality after hospital admission for myocardial infarction. METHODS We used data from 4 1-month French registries, conducted 5 years apart from 1995 to 2010, including 3389 elderly patients (≥75 years of age). RESULTS From 1995 to 2010, mean age remained stable (82.1 years), similar in ST- and non-ST-elevation myocardial infarction patients. Obesity, diabetes, hypertension, and hypercholesterolemia increased. History of prior myocardial infarction, stroke, and peripheral artery disease remained stable, while history of heart failure decreased. Major changes in management were noted: early percutaneous coronary intervention, early treatment with antiplatelet agents, low-molecular-weight heparin, beta-blockers, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and statins all increased. Early mortality after hospital admission decreased from 25.0% to 8.4%. One-year mortality decreased from 36.2% to 20.0% (adjusted hazard ratio 2010 vs 1995: 0.47, 0.39-0.57), both for ST-elevation myocardial infarction (36.8% to 21.1%) and non-ST-elevation myocardial infarction (34.8% to 19.1%). Mortality reduction was observed in all age groups, including those ≥85 years of age (from 46.2% to 31.4%). The study period, however, was no longer associated with decreased mortality when variables reflecting management changes were taken into account. CONCLUSIONS Early and 1-year mortality after hospital admission of elderly patients with acute myocardial infarction has substantially decreased over the past 15 years. This improvement is likely mediated by increasing use of recommended management strategies. These data support the application of guidelines derived from trials mostly including younger patients to elderly populations as well.
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Affiliation(s)
- Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), Paris, France; Université Paris-Descartes, Paris, France.
| | - Nadia Aissaoui
- AP-HP; HEGP, Department of Critical Care Unit, Paris, France; Université Paris-Descartes, Paris, France
| | - Guillaume Cayla
- Department of Cardiology, CHU Nîmes, Université de Montpellier, France
| | - Alexandre Lafont
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), Paris, France; Université Paris-Descartes, Paris, France
| | - Elisabeth Riant
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), Paris, France; Université Paris-Descartes, Paris, France
| | - Marco Mennuni
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), Paris, France; Université Paris-Descartes, Paris, France; Humanitas Clinical and Research Center, Cardiovascular Department, Rozzano (Milano), Italy
| | - Olivier Saint-Jean
- AP-HP; HEGP, Department of Geriatrics, Paris, France; Université Paris-Descartes, Paris, France
| | | | - Patrick Jourdain
- Department of Cardiology, Centre Hospitalier de Pontoise, France
| | - Meyer Elbaz
- Department of Cardiology, Toulouse University Hospital, France
| | | | - Vincent Bataille
- Department of Cardiology B and Epidemiology, Toulouse University Hospital, Toulouse, France; UMR INSERM 1027, Toulouse, France
| | - Elodie Drouet
- AP-HP, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Hôpital Saint Antoine, Paris, France; Université Pierre et Marie Curie (UPMC-Paris 06); INSERM U-698, Paris, France
| | | | - François Schiele
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France
| | - Jean Ferrières
- Department of Cardiology B and Epidemiology, Toulouse University Hospital, Toulouse, France; UMR INSERM 1027, Toulouse, France
| | - Tabassome Simon
- AP-HP, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Hôpital Saint Antoine, Paris, France; Université Pierre et Marie Curie (UPMC-Paris 06); INSERM U-698, Paris, France
| | - Nicolas Danchin
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), Paris, France; Université Paris-Descartes, Paris, France
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10
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Schoenenberger AW, Radovanovic D, Windecker S, Iglesias JF, Pedrazzini G, Stuck AE, Erne P. Temporal trends in the treatment and outcomes of elderly patients with acute coronary syndrome. Eur Heart J 2016; 37:1304-1311. [DOI: 10.1093/eurheartj/ehv698] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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11
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Lopes RD, Gharacholou SM, Holmes DN, Thomas L, Wang TY, Roe MT, Peterson ED, Alexander KP. Cumulative incidence of death and rehospitalization among the elderly in the first year after NSTEMI. Am J Med 2015; 128:582-90. [PMID: 25660246 DOI: 10.1016/j.amjmed.2014.12.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 12/29/2014] [Accepted: 12/30/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Age is associated with outcomes in non-ST-segment elevation myocardial infarction; however, less is known about rehospitalization or death among elderly survivors. We aimed to evaluate mortality and cause-specific rehospitalization rates in this growing population of older adults with ischemic heart disease. METHODS We linked 36,711 patients aged ≥65 years who survived an index non-ST-segment elevation myocardial infarction from the CRUSADE registry to Medicare claims data for follow-up. One-year survival estimates were compared by age group-65-79, 80-84, 85-89, and ≥90 years-and Cox models were used to analyze the association between age and 1-year mortality. RESULTS Death at 1 year increased markedly with age (from 13.3% for 65-79 years to 45.5% for ≥90 years). In contrast, rehospitalization rates at 1 year were similar and high across ages (65-79 years, 52.7%; ≥90 years, 56.5%), with nearly as many noncardiovascular-related as cardiovascular-related rehospitalizations. At 1 year, nonagenarians had substantially higher rates of death with or without preceding rehospitalization and twice the adjusted mortality than the group aged 65-79 years. CONCLUSIONS Evolving care delivery models should consider the high mortality in older adults after a non-ST-segment elevation myocardial infarction. Contrary to expectations, rehospitalization rates do not rise substantially with advancing age, and rehospitalization is often for noncardiac diagnoses.
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Affiliation(s)
- Renato D Lopes
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
| | | | - DaJuanicia N Holmes
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Laine Thomas
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Tracy Y Wang
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Matthew T Roe
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Karen P Alexander
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
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Dodson JA, Geda M, Krumholz HM, Lorenze N, Murphy TE, Allore HG, Charpentier P, Tsang SW, Acampora D, Tinetti ME, Gill TM, Chaudhry SI. Design and rationale of the comprehensive evaluation of risk factors in older patients with AMI (SILVER-AMI) study. BMC Health Serv Res 2014; 14:506. [PMID: 25370536 PMCID: PMC4239317 DOI: 10.1186/s12913-014-0506-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 10/09/2014] [Indexed: 01/28/2023] Open
Abstract
Background While older adults (age 75 and over) represent a large and growing proportion of patients with acute myocardial infarction (AMI), they have traditionally been under-represented in cardiovascular studies. Although chronological age confers an increased risk for adverse outcomes, our current understanding of the heterogeneity of this risk is limited. The Comprehensive Evaluation of Risk Factors in Older Patients with AMI (SILVER-AMI) study was designed to address this gap in knowledge by evaluating risk factors (including geriatric impairments, such as muscle weakness and cognitive impairments) for hospital readmission, mortality, and health status decline among older adults hospitalized for AMI. Methods/Design SILVER-AMI is a prospective cohort study that is enrolling 3000 older adults hospitalized for AMI from a recruitment network of approximately 70 community and academic hospitals across the United States. Participants undergo a comprehensive in-hospital assessment that includes clinical characteristics, geriatric impairments, and health status measures. Detailed medical record abstraction complements the assessment with diagnostic study results, in-hospital procedures, and medications. Participants are subsequently followed for six months to determine hospital readmission, mortality, and health status decline. Multivariable regression will be used to develop risk models for these three outcomes. Discussion SILVER-AMI will fill critical gaps in our understanding of AMI in older patients. By incorporating geriatric impairments into our understanding of post-AMI outcomes, we aim to create a more personalized assessment of risk and identify potential targets for interventions. Trial registration Trial registration number: NCT01755052.
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Affiliation(s)
- John A Dodson
- Leon H Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, USA.
| | - Mary Geda
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. .,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA. .,Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, CT, USA. .,Department of Health Policy and Administration, Yale School of Public Health, New Haven, CT, USA.
| | - Nancy Lorenze
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Terrence E Murphy
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Heather G Allore
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Peter Charpentier
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Sui W Tsang
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Denise Acampora
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Mary E Tinetti
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Thomas M Gill
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Sarwat I Chaudhry
- Section of General Internal Medicine, Yale University School of Medicine, Harkness Office Building, Room 411, New Haven, CT, 06520, USA.
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Abstract
BACKGROUND Fatigue is prevalent after myocardial infarction (MI) and is a barrier to physical activity (PA). Because PA is an important health behavior in preventing or delaying recurrent MIs, examining the influence of biophysical markers and fatigue on PA is important as a prerequisite to developing effective interventions. OBJECTIVE This study compared PA in 34 men and 38 women, aged 65 and older, 6-8 months post MI, and examined the influence of biophysiological measures and fatigue on PA in this sample. METHODS Using a cross-sectional descriptive correlational design, adults completed a demographic form that included documentation of blood pressure, heart rate, height and weight; the Revised Piper Fatigue Scale (RPFS), and the Community Healthy Activities Model Program for Seniors Physical Activity Questionnaire for Older Adults, and blood collection for measurement of hemoglobin (Hgb), interleukin-6, and B-natriuretic peptide. RESULTS There were no differences in frequency of PA between older men and older women; however, men reported a higher intensity of PA (p = .011). When controlling for sex, age, and biophysiological measures, the RPFS significantly explained 16% of the variance in the frequency of PA (p = .03), with no individual subscale serving as a significant predictor. The RPFS behavior/severity subscale explained 31% of the variance in energy expended on all PA (p < .001) and 40% of the variance in energy expended on moderate-intensity PA (p < .001). CONCLUSION The older adults participating in this study did not participate in the recommended levels of PA, and fatigue significantly influenced PA post MI.
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Affiliation(s)
- Patricia B Crane
- Adult Health Department, The University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Willie M Abel
- School of Nursing, The University of North Carolina at Charlotte, Greensboro, NC, USA
| | - Thomas P McCoy
- Community Practice Department, The University of North Carolina at Greensboro, Greensboro, NC, USA
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Predictive value of social inhibition and negative affectivity for cardiovascular events and mortality in patients with coronary artery disease: the type D personality construct. Psychosom Med 2013; 75:873-81. [PMID: 24163388 DOI: 10.1097/psy.0000000000000001] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Methodological considerations and selected null findings indicate the need to reexamine the Type D construct. We investigated whether associations with cardiac events in patients with coronary artery disease (CAD) involve the specific combination of negative affectivity (NA) and social inhibition (SI), or rather the main effect of either trait alone. METHODS In this 5-year follow-up of 541 patients with CAD, the Type D construct (14-item Type D Scale) was tested by examining a) the interaction of continuous NA and SI z scores and b) a four-group classification defined by low/high trait scores. End points were major adverse cardiac events (MACEs; death, myocardial infarction [MI], coronary revascularization) and cardiac death/MI. RESULTS At follow-up, 113 patients had a MACE, including 47 patients with cardiac death/MI. After adjustment for disease severity, age, sex, and main trait effects, the interaction of NA and SI z scores was associated with MACE (odds ratio [OR] = 1.36, 95% confidence interval [CI] = 1.11-1.67). This continuous measure of Type D was also associated with cardiac death/MI (OR = 1.48, 95% CI = 1.11-1.96) and remained an independent predictor of events after adjustment for depressive symptoms. Using a cutoff of 10 on both NA and SI scales, Type D was associated with an adjusted OR of 1.74 (95% CI = 1.11-2.73) for MACE and an OR of 2.35 (95% CI = 1.26-4.38) for death/MI but was unrelated to noncardiac death. Patients with high NA or SI alone were not at increased risk. CONCLUSIONS Continuous (NA × SI interaction) and dichotomized measures of Type D were associated with cardiovascular events in patients with CAD. Research is needed to explore moderating factors that may alter this association.
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Age-related differences in the effect of psychological distress on mortality: Type D personality in younger versus older patients with cardiac arrhythmias. BIOMED RESEARCH INTERNATIONAL 2013; 2013:246035. [PMID: 24205502 PMCID: PMC3800613 DOI: 10.1155/2013/246035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 08/19/2013] [Indexed: 12/15/2022]
Abstract
Background. Mixed findings in biobehavioral research on heart disease may partly be attributed to age-related differences in the prognostic value of psychological distress. This study sought to test the hypothesis that Type D (distressed) personality contributes to an increased mortality risk following implantable cardioverter defibrillator (ICD) treatment in younger patients but not in older patients. Methods. The Type D Scale (DS14) was used to assess general psychological distress in 455 younger (≤70 y, m = 59.1) and 134 older (>70 y, m = 74.3) ICD patients. End points were all-cause mortality and cardiac death after a median follow-up of 3.2 years. Results. Older patients had more advanced heart failure and a higher mortality rate (n = 34/25%) than younger patients (n = 60/13%), P = 0.001. Cardiac resynchronization therapy (CRT), but not Type D personality, was associated with increased mortality in older patients. Among younger patients, however, Type D personality was associated with an adjusted hazard ratio = 1.91 (95% CI 1.09–3.34) and 2.26 (95% CI 1.16–4.41) for all-cause and cardiac mortality; other predictors were increasing age, CRT, appropriate shocks, ACE-inhibitors, and smoking. Conclusion. Type D personality was independently associated with all-cause and cardiac mortality in younger ICD patients but not in older patients. Cardiovascular research needs to further explore age-related differences in psychosocial risk.
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Cognitive-affective symptoms of depression after myocardial infarction: different prognostic importance across age groups. Psychosom Med 2013; 75:701-8. [PMID: 23873711 DOI: 10.1097/psy.0b013e31829dbd36] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Cognitive-affective symptoms of depression may not be as strongly related to prognosis after myocardial infarction (MI) as somatic depressive symptoms. Because it is not known whether this pattern of results is influenced by the age at which patients are diagnosed as having MI, we examined whether the importance of these symptoms is age dependent in the Enhancing Recovery in Coronary Heart Disease study. METHODS Patients with depression after MI (n = 1823) in the Enhancing Recovery in Coronary Heart Disease study were stratified into the following age groups: younger than 70 years (mean [standard deviation] = 55 [9.0] years) and 70 years or older (mean [standard deviation] = 76 [4.9] years). Measurements included demographic and clinical data and the Beck Depression Inventory. The end point was a composite of recurrent MI and mortality during a mean follow-up of 2.1 years. RESULTS Patients 70 years or older had more severe manifestations of cardiac disease and somatic comorbidities than did patients younger than 70 years (p < .001). During follow-up, 456 patients died or had a recurrent MI. In patients 70 years or older, increasing age, disease severity, and comorbidities--but not depressive symptoms--independently predicted prognosis. In contrast, cognitive-affective symptoms of depression predicted death/MI in patients younger than 70 years (hazard ratio = 1.03, 95% confidence interval = 1.01-1.04, p = .011), after adjustment for disease severity and comorbidities. Somatic symptoms largely explained the link between cognitive-affective symptoms and adverse events, with the exception of hopelessness (hazard ratio = 1.47, 95% confidence interval = 1.11-1.95, p = .007), suggesting that somatic depressive symptoms accurately reflect the depressed mood state in this age group. CONCLUSIONS Somatic symptoms and hopelessness independently predicted death/MI in MI patients younger than 70 years. Research needs to reexamine the modulating effect of age in studies on somatic and cognitive-affective symptoms of post-MI depression.
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Rumsfeld JS, Alexander KP, Goff DC, Graham MM, Ho PM, Masoudi FA, Moser DK, Roger VL, Slaughter MS, Smolderen KG, Spertus JA, Sullivan MD, Treat-Jacobson D, Zerwic JJ. Cardiovascular health: the importance of measuring patient-reported health status: a scientific statement from the American Heart Association. Circulation 2013; 127:2233-49. [PMID: 23648778 DOI: 10.1161/cir.0b013e3182949a2e] [Citation(s) in RCA: 405] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Dodson JA, Arnold SV, Reid KJ, Gill TM, Rich MW, Masoudi FA, Spertus JA, Krumholz HM, Alexander KP. Physical function and independence 1 year after myocardial infarction: observations from the Translational Research Investigating Underlying disparities in recovery from acute Myocardial infarction: Patients' Health status registry. Am Heart J 2012; 163:790-6. [PMID: 22607856 PMCID: PMC3359897 DOI: 10.1016/j.ahj.2012.02.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 02/27/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Acute myocardial infarction (AMI) may contribute to health status declines including "independence loss" and "physical function decline." Despite the importance of these outcomes for prognosis and quality of life, their incidence and predictors have not been well described. METHODS We studied 2,002 patients with AMI enrolled across 24 sites in the TRIUMPH registry who completed assessments of independence and physical function at the time of AMI and 1 year later. Independence was evaluated by the EuroQol-5D (mobility, self-care, and usual activities), and physical function was assessed with the Short Form-12 physical component score. Declines in ≥1 level on EuroQol-5D and >5 points in PCS were considered clinically significant changes. Hierarchical, multivariable, modified Poisson regression models accounting for within-site variability were used to identify predictors of independence loss and physical function decline. RESULTS One-year post AMI, 43.0% of patients experienced health status declines: 12.8% independence loss alone, 15.2% physical function decline alone, and 15.0% both. After adjustment, variables that predicted independence loss included female sex, nonwhite race, unmarried status, uninsured status, end-stage renal disease, and depression. Variables that predicted physical function decline were uninsured status, lack of cardiac rehabilitation referral, and absence of pre-AMI angina. Age was not predictive of either outcome after adjustment. CONCLUSIONS >40% of patients experience independence loss or physical function decline 1 year after AMI. These changes are distinct but can occur simultaneously. Although some risk factors are not modifiable, others suggest potential targets for strategies to preserve patients' health status.
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Affiliation(s)
- John A Dodson
- Department of Internal Medicine, Section of Cardiology, Yale University School of Medicine, New Haven, CT 06520, USA.
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Arnold SV, Chan PS, Jones PG, Decker C, Buchanan DM, Krumholz HM, Ho PM, Spertus JA. Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status (TRIUMPH): design and rationale of a prospective multicenter registry. Circ Cardiovasc Qual Outcomes 2011; 4:467-76. [PMID: 21772003 PMCID: PMC3376532 DOI: 10.1161/circoutcomes.110.960468] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 04/11/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND Black patients with myocardial infarction (MI) have worse outcomes than white patients, including higher mortality rates, more angina, and worse quality of life. The Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status (TRIUMPH) study was designed to examine whether racial differences in socioeconomic, clinical, genetic, metabolic, biomarker, or treatment characteristics mediate observed disparities in outcomes. METHODS AND RESULTS Between April 11, 2005, and December 31, 2008, 31 567 patients with MI were prospectively screened; 6152 had an eligible MI, and 4340 (71%) were enrolled from 24 US centers. Consenting patients had detailed chart abstractions of their medical history and processes of inpatient care, supplemented with a detailed baseline interview. Detailed genetic and metabolic data were obtained at hospital discharge in 2979 (69%) and 3013 patients (69%), respectively. In a subset of patients, blood and urine samples were obtained at 1 month (obtained in 27% of survivors) and blood samples at 6 months (obtained in 19% of survivors). Centralized follow-up interviews sought to quantify patients' postdischarge care and outcomes, with a focus on their health status (symptoms, function, and quality of life). At 1, 6, and 12 months, 23%, 27%, and 24%, respectively, were lost to follow-up. Vital status was available for 99% of patients at 12 months. CONCLUSIONS TRIUMPH is a novel MI registry with detailed information on patients' sociodemographic, clinical, treatment, health status, metabolic, and genetic characteristics. The wealth of patient data collected in TRIUMPH will provide unique opportunities to examine factors that may mediate racial differences in mortality and health status after MI and the complex interactions between genetic and environmental determinants of post-MI outcomes.
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Affiliation(s)
- Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO 64111, USA
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Denollet J, Schiffer AA, Spek V. A General Propensity to Psychological Distress Affects Cardiovascular Outcomes. Circ Cardiovasc Qual Outcomes 2010; 3:546-57. [DOI: 10.1161/circoutcomes.109.934406] [Citation(s) in RCA: 251] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Johan Denollet
- From the CoRPS–Center of Research on Psychology in Somatic diseases (J.D., A.A.S., V.S.), Tilburg University, Tilburg, The Netherlands; and the Department of Medical Psychology and Neuropsychology (A.A.S.), TweeSteden Hospital, Tilburg, The Netherlands
| | - Angélique A. Schiffer
- From the CoRPS–Center of Research on Psychology in Somatic diseases (J.D., A.A.S., V.S.), Tilburg University, Tilburg, The Netherlands; and the Department of Medical Psychology and Neuropsychology (A.A.S.), TweeSteden Hospital, Tilburg, The Netherlands
| | - Viola Spek
- From the CoRPS–Center of Research on Psychology in Somatic diseases (J.D., A.A.S., V.S.), Tilburg University, Tilburg, The Netherlands; and the Department of Medical Psychology and Neuropsychology (A.A.S.), TweeSteden Hospital, Tilburg, The Netherlands
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