Association Between Mobility Measured During Hospitalization and Functional Outcomes in Older Adults With Acute Myocardial Infarction in the SILVER-AMI Study

Abstract

IMPORTANCE Many older survivors of acute myocardial infarction (AMI) experience functional decline, an outcome of primary importance to older adults. Mobility impairment has been proposed as a risk factor for functional decline but has not been evaluated to date in older patients hospitalized for AMI. OBJECTIVE To examine the association of mobility impairment, measured during hospitalization, as a risk marker for functional decline among older patients with AMI. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study among 94 academic and community hospitals in the United States. Participants were 2587 hospitalized patients with AMI who were 75 years or older. The study dates were January 2013 to June 2017. MAIN OUTCOMES AND MEASURES Mobility was evaluated during AMI hospitalization using the Timed "Up and Go," with scores categorized as preserved mobility (Յ15 seconds to complete), mild impairment (>15 to Յ25 seconds to complete), moderate impairment (>25 seconds to complete), and severe impairment (unable to complete). Self-reported function in activities of daily living (ADLs) (bathing, dressing, transferring, and walking around the home) and walking 0.4 km (one-quarter mile) was assessed at baseline and 6 months after discharge. The primary outcomes were worsening of 1 or more ADLs and loss of ability to walk 0.4 km from baseline to 6 months after discharge. The association between mobility impairment and risk of functional decline was evaluated with multivariable-adjusted logistic regression. RESULTS Among 2587 hospitalized patients with AMI, the mean (SD) age was 81.4 (4.8) years, and 1462 (56.5%) were male. More than half of the cohort exhibited mobility impairment during AMI hospitalization (21.8% [564 of 2587] had mild impairment, 16.0% [414 of 2587] had moderate impairment, and 15.2% [391 of 2587] had severe impairment); 12.8% (332 of 2587) reported ADL decline, and 16.7% (431 of 2587) reported decline in 0.4-km mobility. Only 3.8% (30 of 800) of participants with preserved mobility experienced any ADL decline compared with 6.9% (39 of 564) of participants with mild impairment (adjusted odds ratio [aOR], 1.24; 95% CI, 0.74-2.09), 18.6% (77 of 414) of participants with moderate impairment (aOR, 2.67; 95% CI, 1.67-4.27), and 34.7% (136 of 391) of participants with severe impairment (aOR, 5.45; 95% CI, 3.29-9.01). Eleven percent (90 of 800) of participants with preserved mobility declined in ability to walk 0.4 km compared with 15.2% (85 of 558) of participants with mild impairment (aOR, 1.51; 95% CI, 1.04-2.20), 19.0% (78 of 411) of participants with moderate impairment (aOR, 2.03; 95% CI, 1.37-3.02), and 24.6% (95 of 386) of participants with severe impairment (aOR, 3.25; 95% CI, 2.02-5.23). CONCLUSIONS AND RELEVANCE This study's findings suggest that mobility impairment assessed during hospitalization may be a potent risk marker for functional decline in older survivors of AMI. These findings also suggest that brief, validated assessments of mobility should be part of the care of older hospitalized ...

Multimorbidity Patterns and the Disablement Process among Public Long-Term Care Insurance Claimants in the City of Yiwu (Zhejiang Province, China)

“…Lower limb fractures were associated with mobility impairment [ 8 , 19 , 20 ], and there was a high prevalence of incontinence in older adults with fractures [ 21 ]. Mobility impairment [ 22 , 23 ], incontinence [ 24 , 25 ], and vision impairment [ 26 , 27 , 28 ] were associated with the likelihood of disability.…”

Racial disparities among older adults with acute myocardial infarction: The SILVER‐AMI study

“…25 We focused on 6-month mortality because it was the outcome for which a previously described risk model using data from the SILVER-AMI study had excellent discriminatory ability, providing precision for examining disparities. 6,26 We built our models using covariates from the SILVER-AMI 6-month mortality model. Variables were evaluated for correlation to help avoid model overfitting.…”

“…We performed logistic regression to examine the association of race (Black vs White participants) with 6‐month mortality after adjusting for validated risk factors specific to older AMI patients 25 . We focused on 6‐month mortality because it was the outcome for which a previously described risk model using data from the SILVER‐AMI study had excellent discriminatory ability, providing precision for examining disparities 6,26 . We built our models using covariates from the SILVER‐AMI 6‐month mortality model.…”

Presentation, Treatment, and Outcomes of Older Adults Hospitalized for Acute Myocardial Infarction According to Cognitive Status: The SILVER-AMI Study

“…26 It is important to note that CI, both mild and moderate-to-severe, were associated with increased risk of readmission in our unadjusted model. However, we posit that adjustment for other important geriatric impairments, such as mobility impairment, a marker of frailty that has been shown to be an extremely potent predictor of outcomes among older acute myocardial infarction patients, 5,27 may outweigh the risks posed by CI for readmission; these important factors have not been adjusted for in prior studies. It is also possible that the traumatic nature of hospitalization (eg, poor sleep and diet, anxiety about one's health) may cause participants whose cognition is assessed during hospitalization to score lower than they would if assessed in a nonhospital setting; this, in turn, may dilute the association between cognitive status and outcomes assessed several months after discharge, by when cognitive status may have recovered.…”