Background
We assessed the acute and long-term impact of MI and stroke on post-event functional disability and cognition while controlling for survivors’ changes in functioning over the years before the event.
Methods and Results
Among participants in the nationally-representative Health and Retirement Study with linked Medicare data (1998-2010), we determined within-person changes in functional limitations (basic and instrumental activities of daily living) and cognitive impairment after hospitalization for stroke (n=432) and MI (n=450), controlling for pre-morbid functioning using fixed-effects regression. In persons without baseline impairments, an acute MI yielded a mean increase of 0.41 functional limitations (95% CI, 0.18-0.63) with a linear increase of 0.14 limitations/year in the following decade. These increases were 0.65 limitations (95% CI, 0.07-1.23) and 0.27 limitations/year afterwards for those with mild-to-moderate impairment at baseline. Stroke resulted in an increase of 2.07 (95% CI, 1.51-2.63) limitations due to the acute event and an increase of 0.15 limitations/year afterwards for those unimpaired at baseline. There were 2.65 new limitations (95% CI, 1.86-3.44) and 0.19/year afterwards for those with baseline mild-to-moderate impairment. Stroke hospitalization was associated with greater odds of moderate-to-severe cognitive impairment (odds ratio, 3.86; 95% CI, 2.10-7.11) at the time of the event, after adjustment for premorbid cognition but MI hospitalization was not.
Conclusions
In this population-based cohort, most MI and stroke hospitalizations were associated with significant increases in functional disability at the time of the event and in the decade afterwards. Survivors of MI and stroke warrant screening for functional disability over the long-term.