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In older adults, functional mobility influences 30-day readmission rates after MI
Functional mobility among older adults after acute MI is a strong predictor of readmission within a 30-day period, according to findings published in Circulation: Cardiovascular Quality and Outcomes.
John A. Dodson, MD, MPH, and colleagues sought to develop and validate an acute MI readmission risk model for older patients that considered functional impairments and could be used before hospital discharge.
“In general, there has been a lot of interest in preventing hospital readmissions among older patients within 30 days of discharge from the hospital because of how common and costly they are,” Dodson, an assistant professor of medicine and population health, and the director of the NYU Geriatric Cardiology program, said in a press release. “Heart attack is one of the conditions specifically identified by Medicare as a priority for readmissions reduction, but so far it’s been challenging to predict specifically which patients with heart attack get readmitted.”
Evaluating readmission rates
Dodson and colleagues analyzed data from the SILVER-AMI study consisting of 3,006 patients aged 75 years and older (mean age, 81 years; 44% women; 10% nonwhite) with acute MI from 94 U.S. hospitals.
Participants underwent in-hospital assessment of functional impairments including cognition, vision, hearing and mobility, the researchers wrote. The outcome was all-cause admission at 30 days.
The researchers included 2,004 patients in the risk model’s derivation cohort and 1,002 in the validation cohort.
Within 30 days, 547 participants were readmitted, according to the researchers.
Compared with those who were not readmitted, participants who were readmitted were older, had more comorbidities and had a higher prevalence of functional impairments including activities of daily living disability (17% vs. 13%; P = .013) and impaired functional mobility (72.5% vs. 53.6%; P < .001), Dodson and colleagues wrote.
The final risk model included eight variables: functional mobility, ejection fraction, chronic obstructive pulmonary disease, arrhythmia, acute kidney injury, first diastolic BP, P2Y12 inhibitor use and general health status, the researchers wrote.
Functional mobility was the only functional impairment variable retained but was the strongest predictor, the researchers wrote.
The model was well-calibrated (Hosmer-Lemeshow P > .05) with moderate discrimination (C statistic = 0.65 in derivation cohort, 0.63 in validation cohort), Dodson and colleagues wrote.
Functional mobility improved performance of the risk model (net reclassification improvement index = 20%; P < .001), the researchers wrote.
“Impaired performance on the functional mobility test is a marker of generalized vulnerability to the stresses that can lead a patient to be readmitted to the hospital, such as infection, falls and recurrent cardiovascular events,” Dodson said in the release. “There’s considerable overlap between impaired mobility and something called the frailty syndrome, which is generally thought of as increased vulnerability to these stresses.”
Step forward
Further research is needed to evaluate interventions for improving patient-centered outcomes, Michael W. Rich, MD, FAHA, FACC, a professor of medicine at Washington University School of Medicine in St. Louis, wrote in a related editorial.
“SILVER-AMI represents an important step forward in understanding the health status of older adults hospitalized with [acute] MI, as well as the factors that impact clinical outcomes.” – by Earl Holland Jr.
Disclosures: The authors and Rich report no relevant financial disclosures.