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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.
摘要：
背景功能下降(即，进行独立生活所必需的日常活动的能力下降）在急性心肌梗死（AMI）后很常见，并且与不良的长期预后相关；然而，我们没有一个工具来确定老年AMI幸存者有这种以患者为中心的重要结局的风险.方法和结果我们使用了3041例AMI患者的前瞻性SILVER-AMI（老年急性心肌梗死危险因素的综合评估）研究数据，年龄≥75岁，从94家美国医院招募。参与者在住院期间和6个月时进行评估，以收集人口统计数据，老年性损伤，社会心理因素,和日常生活活动。从病历中提取临床变量。功能衰退被定义为独立执行日常生活基本活动的能力下降(即，洗澡,敷料,转移,和下床活动）从基线到出院后6个月。样本的平均年龄为82±5岁；57%为男性，90%是白人,13%报告出院后6个月日常生活活动能力下降。该模型确定了年龄较大，住院时间更长，住院期间的行动障碍，入院前的体力活动，和抑郁是衰退的危险因素。AMI住院期间的血运重建和AMI前四分之一英里的行走能力与风险降低相关。模型辨别(c=0.78)和校准良好。结论我们确定了一个简约模型，可以预测老年AMI患者日常生活活动能力下降的风险。该工具可能有助于识别老年AMI患者，他们可能受益于恢复性治疗，以优化AMI后的功能。
