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Mobility impairment during hospitalization for MI may predict functional decline
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Impaired mobility during hospitalization for acute MI may be a risk factor for functional decline among older patients who survived the event, according to a study published in JAMA Internal Medicine.
“It is increasingly recognized that many older adults who are hospitalized head home in worse shape than when they arrived,” Alexandra M. Hajduk, PhD, MPH, associate director of the T32 training program in geriatric clinical epidemiology and aging-related research and associate research scientist in the section of geriatrics at Yale School of Medicine, told Healio | Cardiology Today. “They may have trouble navigating their home or community and performing tasks that are essential for independence — things like taking a shower or walking around the block. In this nationwide study, we found that one in four older heart attack patients reported new limitations in these essential activities 6 months after their heart attack, and that a quick, easy-to-administer walking assessment in the hospital may help to identify patients at risk for this important outcome.”
SILVER-AMI data
Researchers analyzed data from 2,587 participants (mean age, 81 years; 57% men) from the SILVER-AMI study who were hospitalized with acute MI. Participants underwent physical assessment and a structured interview at baseline during hospitalization to collect information on functional status, geriatric impairments, psychosocial characteristics and demographics. Follow-up interviews were conducted 6 months after discharge.
Mobility was assessed using Timed “Up and Go,” during which participants rose from a seated position, walked 3 m, turned, walked 3 m back to the chair then sat down. Participants were then categorized by their time to complete the tasks: preserved mobility ( 15 seconds; n = 800), mild impairment (> 15 seconds to 25 seconds; n = 564), moderate impairment (> 25 seconds; n = 414) and severe impairment (unable to complete; n = 391).
Primary outcomes included a loss of ability to walk 0.4 km and a decrease in the ability to independently perform one or more essential activity of daily living 6 months after discharge.
Six months after discharge, 16.7% of participants reported decline in 0.4 km mobility and 12.8% reported decline in activities of daily living.
With regard to decline in activities of daily living, 3.8% of participants with preserved mobility had experienced a decline compared with 6.9% with mild impairment (adjusted OR = 1.24; 95% CI, 0.74-2.09), 18.6% with moderate impairment (aOR = 2.67; 95% CI, 1.67-4.27) and 34.7% with severe impairment (aOR = 5.45; 95% CI, 3.29-9.01).
Declines in the ability to walk 0.4 km occurred in 11% of participants with preserved mobility vs. 15.2% with mild impairment (aOR = 1.51; 95% CI, 1.04-2.2), 19% with moderate impairment (aOR = 2.03; 95% CI, 1.37-3.02) and 24.6% with severe impairment (aOR = 3.25; 95% CI, 2.02-5.23).
Future course of action
“We’re getting better at identifying older heart attack patients who may be at risk for new activity limitations, but what we can do for those at risk remains unclear,” Hajduk said in an interview. “Might physical therapy before hospital discharge make a difference? Could cardiac rehab be tailored to meet the special recovery needs of these patients? These are questions that will need to be addressed in future studies.” – by Darlene Dobkowski
For more information:
Alexandra M. Hajduk, PhD, MPH, can be reached at 333 Cedar Street, P.O. Box 205025, New Haven, CT 06520; email: alexandra.hajduk@yale.edu; Twitter: @AlexandraHajduk.
Disclosures: Hajduk reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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