180-day readmission risk model for older adults with acute myocardial infarction: the SILVER-AMI study
Objective To develop a 180-day readmission risk model for older adults with acute myocardial infarction (AMI) that considered a broad range of clinical, demographic and age-related functional domains.Methods We used data from ComprehenSIVe Evaluation of Risk in Older Adults with AMI (SILVER-AMI), a...
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| Format: | Article |
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BMJ Publishing Group
2021-02-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/8/1/e001442.full |
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| author | Harlan M Krumholz Sarwat I Chaudhry John A Dodson Alexandra M Hajduk Terrence E Murphy Mary Geda Sui Tsang Michael G Nanna Mary E Tinetti Gregory Ouellet Deborah Sybrant Thomas M Gill |
| author_facet | Harlan M Krumholz Sarwat I Chaudhry John A Dodson Alexandra M Hajduk Terrence E Murphy Mary Geda Sui Tsang Michael G Nanna Mary E Tinetti Gregory Ouellet Deborah Sybrant Thomas M Gill |
| author_sort | Harlan M Krumholz |
| collection | DOAJ |
| description | Objective To develop a 180-day readmission risk model for older adults with acute myocardial infarction (AMI) that considered a broad range of clinical, demographic and age-related functional domains.Methods We used data from ComprehenSIVe Evaluation of Risk in Older Adults with AMI (SILVER-AMI), a prospective cohort study that enrolled participants aged ≥75 years with AMI from 94 US hospitals. Participants underwent an in-hospital assessment of functional impairments, including cognition, vision, hearing and mobility. Clinical variables previously shown to be associated with readmission risk were also evaluated. The outcome was 180-day readmission. From an initial list of 72 variables, we used backward selection and Bayesian model averaging to derive a risk model (N=2004) that was subsequently internally validated (N=1002).Results Of the 3006 SILVER-AMI participants discharged alive, mean age was 81.5 years, 44.4% were women and 10.5% were non-white. Within 180 days, 1222 participants (40.7%) were readmitted. The final risk model included 10 variables: history of chronic obstructive pulmonary disease, history of heart failure, initial heart rate, first diastolic blood pressure, ischaemic ECG changes, initial haemoglobin, ejection fraction, length of stay, self-reported health status and functional mobility. Model discrimination was moderate (0.68 derivation cohort, 0.65 validation cohort), with good calibration. The predicted readmission rate (derivation cohort) was 23.0% in the lowest quintile and 65.4% in the highest quintile.Conclusions Over 40% of participants in our sample experienced hospital readmission within 180 days of AMI. Our final readmission risk model included a broad range of characteristics, including functional mobility and self-reported health status, neither of which have been previously considered in 180-day risk models. |
| format | Article |
| id | doaj-art-35a947b25480413aa854eb5831576f3d |
| institution | Kabale University |
| issn | 2053-3624 |
| language | English |
| publishDate | 2021-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj-art-35a947b25480413aa854eb5831576f3d2024-11-12T04:50:08ZengBMJ Publishing GroupOpen Heart2053-36242021-02-018110.1136/openhrt-2020-001442180-day readmission risk model for older adults with acute myocardial infarction: the SILVER-AMI studyHarlan M Krumholz0Sarwat I Chaudhry1John A Dodson2Alexandra M Hajduk3Terrence E Murphy4Mary Geda5Sui Tsang6Michael G Nanna7Mary E Tinetti8Gregory Ouellet9Deborah Sybrant10Thomas M Gill11Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USASection of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USALeon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USAGeriatrics Section, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USAGeriatrics Section, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USAGeriatrics Section, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USAGeriatrics Section, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USADuke Clinical Research Institute, Durham, North Carolina, USADepartment of Internal Medicine (Geriatrics), Yale School of Medicine, New Haven, CT 06520, USAGeriatrics Section, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USAInternational Heart Institute of Montana, Missoula, Montana, USAprofessorObjective To develop a 180-day readmission risk model for older adults with acute myocardial infarction (AMI) that considered a broad range of clinical, demographic and age-related functional domains.Methods We used data from ComprehenSIVe Evaluation of Risk in Older Adults with AMI (SILVER-AMI), a prospective cohort study that enrolled participants aged ≥75 years with AMI from 94 US hospitals. Participants underwent an in-hospital assessment of functional impairments, including cognition, vision, hearing and mobility. Clinical variables previously shown to be associated with readmission risk were also evaluated. The outcome was 180-day readmission. From an initial list of 72 variables, we used backward selection and Bayesian model averaging to derive a risk model (N=2004) that was subsequently internally validated (N=1002).Results Of the 3006 SILVER-AMI participants discharged alive, mean age was 81.5 years, 44.4% were women and 10.5% were non-white. Within 180 days, 1222 participants (40.7%) were readmitted. The final risk model included 10 variables: history of chronic obstructive pulmonary disease, history of heart failure, initial heart rate, first diastolic blood pressure, ischaemic ECG changes, initial haemoglobin, ejection fraction, length of stay, self-reported health status and functional mobility. Model discrimination was moderate (0.68 derivation cohort, 0.65 validation cohort), with good calibration. The predicted readmission rate (derivation cohort) was 23.0% in the lowest quintile and 65.4% in the highest quintile.Conclusions Over 40% of participants in our sample experienced hospital readmission within 180 days of AMI. Our final readmission risk model included a broad range of characteristics, including functional mobility and self-reported health status, neither of which have been previously considered in 180-day risk models.https://openheart.bmj.com/content/8/1/e001442.full |
| spellingShingle | Harlan M Krumholz Sarwat I Chaudhry John A Dodson Alexandra M Hajduk Terrence E Murphy Mary Geda Sui Tsang Michael G Nanna Mary E Tinetti Gregory Ouellet Deborah Sybrant Thomas M Gill 180-day readmission risk model for older adults with acute myocardial infarction: the SILVER-AMI study Open Heart |
| title | 180-day readmission risk model for older adults with acute myocardial infarction: the SILVER-AMI study |
| title_full | 180-day readmission risk model for older adults with acute myocardial infarction: the SILVER-AMI study |
| title_fullStr | 180-day readmission risk model for older adults with acute myocardial infarction: the SILVER-AMI study |
| title_full_unstemmed | 180-day readmission risk model for older adults with acute myocardial infarction: the SILVER-AMI study |
| title_short | 180-day readmission risk model for older adults with acute myocardial infarction: the SILVER-AMI study |
| title_sort | 180 day readmission risk model for older adults with acute myocardial infarction the silver ami study |
| url | https://openheart.bmj.com/content/8/1/e001442.full |
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