Clinical study: myocardial infarction
Predicting one-year mortality among elderly survivors of hospitalization for an acute myocardial infarction: results from the Cooperative Cardiovascular Project

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Abstract

OBJECTIVES

We sought to develop a model based on information available from the medical record that would accurately stratify elderly patients who survive hospitalization with an acute myocardial infarction (AMI) according to their risk of one-year mortality.

BACKGROUND

Prediction of the risk of mortality among older survivors of an AMI has many uses, yet few studies have determined the prognostic importance of demographic, clinical and functional data that are available on discharge in a population-based sample.

METHODS

In a cohort of patients aged ≥65 years who survived hospitalization for a confirmed AMI from 1994 to 1995 at acute care, nongovernmental hospitals in the U.S., we developed a parsimonious model to stratify patients by their risk of one-year mortality.

RESULTS

The study sample of 103,164 patients, with a mean age of 76.8 years, had a one-year mortality of 22%. The factors with the strongest association with mortality were older age, urinary incontinence, assisted mobility, presence of heart failure or cardiomegaly any time before discharge, presence of peripheral vascular disease, body mass index <20 kg/m2, renal dysfunction (defined as creatinine >2.5 mg/dl or blood urea nitrogen >40 mg/dl) and left ventricular dysfunction (left ventricular ejection fraction <40%). On the basis of the coefficients in the model, patients were stratified into risk groups ranging from 7% to 49%.

CONCLUSIONS

We demonstrate that a simple risk model can stratify older patients well by their risk of death one year after discharge for AMI.

Abbreviations

AMI
acute myocardial infarction
AROC
area under the receiver operating characteristic
CCP
Cooperative Cardiovascular Project
GUSTO
Global Utilization of Streptokinase and tPA for Occluded Coronary Arteries
ICD-9-CM
International Classification of Diseases, Ninth Revision, Clinical Modification
LVEF
left ventricular ejection fraction
PREDICT
Predicting Risk of Death in Cardiac Disease Tool
ROC
receiver operating characteristic

Cited by (0)

The analyses upon which this publication is based were performed under Contract Number 500-96-P549, entitled “Utilization and Quality Control Peer Review Organization for the State of Connecticut,” sponsored by the Health Care Financing Administration, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products or organizations imply endorsement by the U.S. Government. The author assumes full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Health Care Financing Administration, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this contractor. Ideas and contributions to the author concerning experience in engaging with issues presented are welcomed.

1

Dr. Jersey Chen’s current affiliation is Beth Israel/Deaconess Medical Center, Boston, Massachusetts

2

Dr. Ya-Ting Chen’s current affiliation is Merck and Co., West Point, Pennsylvania.