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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Autores principales:	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
Formato:	article
Lenguaje:	EN
Publicado:	BMJ Publishing Group 2021
Materias:	Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/35a947b25480413aa854eb5831576f3d
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spelling	oai:doaj.org-article:35a947b25480413aa854eb5831576f3d2021-11-25T03:30:05Z180-day readmission risk model for older adults with acute myocardial infarction: the SILVER-AMI study10.1136/openhrt-2020-0014422053-3624https://doaj.org/article/35a947b25480413aa854eb5831576f3d2021-06-01T00:00:00Zhttps://openheart.bmj.com/content/8/1/e001442.fullhttps://doaj.org/toc/2053-3624Objective 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.Sarwat I ChaudhryJohn A DodsonAlexandra M HajdukTerrence E MurphyMary GedaSui TsangMichael G NannaMary E TinettiGregory OuelletDeborah SybrantThomas M GillBMJ Publishing GrouparticleDiseases of the circulatory (Cardiovascular) systemRC666-701ENOpen Heart, Vol 8, Iss 1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Diseases of the circulatory (Cardiovascular) system RC666-701 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
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
author	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	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	Sarwat I Chaudhry
title	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_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_sort	180-day readmission risk model for older adults with acute myocardial infarction: the silver-ami study
publisher	BMJ Publishing Group
publishDate	2021
url	https://doaj.org/article/35a947b25480413aa854eb5831576f3d
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180-day readmission risk model for older adults with acute myocardial infarction: the SILVER-AMI study

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