Reference
Dodson JA, Hajduk AM, Murphy TE et al. 180-day readmission risk model for older adults with acute myocardial infarction: the SILVER-AMI study. Open Heart. 2021 Jan;8(1):e001442
Summary
Older patients are at high risk of re-hospitalization in the first months following an acute coronary syndrome. The SILVER-AMI study has identified and validated a risk score that includes 10 clinical variables able to estimate the increased risk of re-hospitalization 6 months after an elderly person has experienced an acute coronary event.
Context
Elderly patients undergoing hospitalization for acute coronary syndrome have a high risk of re-hospitalization, mainly in the first months following the index event. This risk is driven by multiple comorbidities and the intrinsic frailty of the older population. It is currently unclear which clinical features might play a more prevalent role in this increased risk. In order to define a risk score for the re-hospitalization of elderly patients, the SILVER-AMI study investigated a series of clinical variables at 180 days after an acute coronary syndrome.
Study characteristics
The SILVER-AMI study is a prospective, multi-center, cohort study conducted in the United States on patients aged >75 years admitted for acute coronary syndrome. Clinical and demographic characteristics were collected upon admission and at a 6-month follow-up. In the risk model, 72 distinct clinical variables were evaluated, including indices of functional and cognitive impairment. A multivariate statistical analysis with logistic regression was performed to identify main predictors of re-hospitalization within 6 months.
Main results
The study enrolled 3,006 patients, with a mean age of 81.5 years; females represented 44% of the sample. A total of 1,222 patients (40.7%) underwent a new hospitalization in the following 6 months, in most cases due to cardiovascular causes (61% of cases). The main cardiovascular causes were: heart failure (17.7%), myocardial infarction without elevated ST (8.4%), or major arrhythmias (6.1%). Among non-cardiovascular causes, major bleeding was predominant (9.1%). Overall mortality at 6 months was 8.8%.Statistical analysis identified 10 variables that could to predict an increased risk of re-hospitalization: history of heart failure (Odds Ratio, OR, 1.85, 95% confidence interval 1.46-2.34); history of COPD (chronic obstructive pulmonary disease) (OR 1.54, 1.16-2.04); an impaired functional state, assessed by means of the Short-Form 12 questionnaire (OR 1.17, 1.07-1.29); EKG abnormalities (OR 1.15, 1.03-1.29); impaired mobility (OR 1.13, 1.04-1.23); reduction of the left ventricular ejection fraction (OR 1.12, 1.02-1.23); increased baseline heart rate (OR 1.06, 1.00-1.11); prolonged length of stay for the acute coronary syndrome event (OR 1.02, 1.00-1.04). Non-reduced values of diastolic blood pressure (OR 0.92, 0.88-0.97) and of hemoglobin (OR 0.90, 0.86-0.94) were associated with a reduced risk of re-hospitalization.
What’s new?
The SILVER-AMI study identified and validated a risk score of 10 easily assessable clinical variables for elderly patients with acute coronary syndrome. These risk factors significantly increased the risk of re-hospitalization at 6 months. Therefore, in consideration of these variables, close clinical monitoring of such an extremely fragile population is needed during follow-up, with the aim of early identification of physical and/or functional deterioration.
Edited by Giuseppe Patti
