University of Massachusetts Medical School Faculty Publications

Title

Presentation, Treatment, and Outcomes of Older Adults Hospitalized for Acute Myocardial Infarction according to Cognitive Status: the SILVER-AMI Study

UMMS Affiliation

Department of Population and Quantitative Health Sciences

Publication Date

2021-03-15

Document Type

Article

Disciplines

Cardiovascular Diseases | Geriatrics | Psychiatry and Psychology

Abstract

INTRODUCTION: While survival after acute myocardial infarction has improved substantially, older adults remain at heightened risk for poor hospital readmissions and death. Evidence for the role of cognitive impairment in older myocardial infarction survivors' risk for these outcomes is limited.

METHODS: 3,006 patients age > /=75 hospitalized with acute myocardial infarction (mean age 82+/-5 years, 56% male) were recruited from 94 U.S. hospitals. Cognition was assessed using the Telephone Interview for Cognitive Status; scores of < 27 and < 22 indicated mild and moderate/severe impairment. Readmissions and death at six months post-discharge were ascertained via participant report and medical record review. Associations between cognitive and outcomes were evaluated with multivariable-adjusted logistic regression.

RESULTS: Mild and moderate/severe cognitive impairment were present in 11% and 6% of the cohort. Readmission and death at six months occurred in 41% and 9% of participants. Mild and moderate/severe cognitive impairment were associated with increased risk of readmission (ORs=1.36, 95%CI 1.08-1.72 and 1.58, 95%CI 1.18-2.12, respectively) and death (ORs=2.19, 95%CI 1.54-3.11 and 3.82, 95%CI 2.63-5.56, respectively) in unadjusted analyses. Significant associations between moderate/severe cognitive impairment and death persisted after adjustment for demographics, myocardial infarction characteristics, comorbidity burden, functional status, and depression (OR=1.69, 95%CI 1.10-2.59), but not for readmissions.

CONCLUSIONS: Moderate-to-severe cognitive impairment is associated with heightened risk of death in older acute myocardial infarction patients in the months after hospitalization, but not with readmission. Routine cognitive screening may identify older myocardial infarction survivors at risk for poor outcomes, who may benefit from closer oversight and support in the post-discharge period.

Keywords

Acute myocardial infarction, cognition, older adults, outcomes

DOI of Published Version

10.1016/j.amjmed.2021.03.003

Source

Hajduk AM, Saczynski JS, Tsang S, Geda ME, Dodson JA, Ouellet GM, Goldberg RJ, Chaudhry SI. Presentation, Treatment, and Outcomes of Older Adults Hospitalized for Acute Myocardial Infarction according to Cognitive Status: the SILVER-AMI Study. Am J Med. 2021 Mar 15:S0002-9343(21)00155-8. doi: 10.1016/j.amjmed.2021.03.003. Epub ahead of print. PMID: 33737057. Link to article on publisher's site

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

The American journal of medicine

PubMed ID

33737057

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