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Lee S, McAvay GJ, Geda M, Chattopadhyay S, Acampora D, Araujo K, Charpentier P, Gill TM, Hajduk AM, Cohen AB, Ferrante LE. Associations of Social Support With Physical and Mental Health Symptom Burden After COVID-19 Hospitalization Among Older Adults. J Gerontol A Biol Sci Med Sci 2024; 79:glae092. [PMID: 38558166 PMCID: PMC11059296 DOI: 10.1093/gerona/glae092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Despite significant support system disruptions during the coronavirus 2019 (COVID-19) pandemic, little is known about the relationship between social support and symptom burden among older adults following COVID-19 hospitalization. METHODS From a prospective cohort of 341 community-living persons aged ≥60 years hospitalized with COVID-19 between June 2020 and June 2021 who underwent follow-up at 1, 3, and 6 months after discharge, we identified 311 participants with ≥1 follow-up assessment. Social support prehospitalization was ascertained using a 5-item version of the Medical Outcomes Study Social Support Survey (range, 5-25), with low social support defined as a score ≤15. At hospitalization and each follow-up assessment, 14 physical symptoms were assessed using a modified Edmonton Symptom Assessment System inclusive of COVID-19-relevant symptoms. Mental health symptoms were assessed using Patient Health Questionnaire-4. Longitudinal associations between social support and physical and mental health symptoms, respectively, were evaluated through multivariable regression. RESULTS Participants' mean age was 71.3 years (standard deviation, 8.5), 52.4% were female, and 34.2% were of Black race or Hispanic ethnicity. 11.8% reported low social support. Over the 6-month follow-up period, low social support was independently associated with higher burden of physical symptoms (adjusted rate ratio [aRR], 1.26; 95% confidence interval [CI], 1.05-1.52), but not mental health symptoms (aRR, 1.14; 95% CI, 0.85-1.53). CONCLUSIONS Low social support is associated with greater physical, but not mental health, symptom burden among older survivors of COVID-19 hospitalization. Our findings suggest a potential need for social support screening and interventions to improve post-COVID-19 symptom management in this vulnerable group.
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Affiliation(s)
- Seohyuk Lee
- Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Gail J McAvay
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mary Geda
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sumon Chattopadhyay
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Denise Acampora
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Katy Araujo
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Thomas M Gill
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Alexandra M Hajduk
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Andrew B Cohen
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lauren E Ferrante
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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2
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Brush JE, Chaudhry SI, Dreyer RP, D'Onofrio G, Greene EJ, Hajduk AM, Lu Y, Krumholz HM. Sex Differences in Symptom Complexity and Door-to-Balloon Time in Patients With ST-Elevation Myocardial Infarction. Am J Cardiol 2023; 197:101-107. [PMID: 37062667 PMCID: PMC10198892 DOI: 10.1016/j.amjcard.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/08/2023] [Accepted: 03/13/2023] [Indexed: 04/18/2023]
Abstract
Greater symptom complexity in women than in men could slow acute ST-elevation myocardial infarction (STEMI) recognition and delay door-to-balloon (D2B) times. We sought to determine the sex differences in symptom complexity and their relation to D2B times in 1,677 young and older patients with STEMI using data from the VIRGO and SILVER-AMI studies. Symptom complexity was defined by the number of symptom patterns or phenotypes and average number of symptoms. The numbers of symptom phenotypes were compared in women and men using the Monte Carlo permutation testing. Groups were also compared using the generalized linear regression and logistic regression. The number of symptom phenotypes (244 vs 171, p = 0.02), mean number of symptoms (4.7 vs 4.2, p <0.001), and mean D2B time (114.6 vs 97.8 minutes, p = 0.004) were greater in young women than in young men but were not significantly different in older women compared with older men. The regression analysis did not show a relation between symptom complexity and D2B time overall; although, chest pain was a significant predictor of D2B times, and young women were more likely to report symptoms other than chest pain. Among patients with STEMI, 36% did not receive percutaneous coronary intervention (PCI), which was associated with presentation delay >6 hours. In patients with STEMI with either D2B time ≥90 minutes or no PCI, women had significantly more symptom phenotypes overall and in VIRGO but not in SILVER-AMI. In conclusion, the markers of symptom complexity were not associated with D2B time overall, but more symptom phenotypes in young women were associated with prolonged D2B time or no PCI. In addition, greater frequency of nonchest pain symptoms in young women may have also slowed the recognition of STEMI and D2B times in young women. Further research on symptoms clusters is needed to improve the recognition of STEMIs to improve the D2B times in young women.
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Affiliation(s)
- John E Brush
- Sentara Healthcare and Eastern Virginia Medical School, Norfolk, Virginia.
| | - Sarwat I Chaudhry
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Rachel P Dreyer
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Erich J Greene
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Alexandra M Hajduk
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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3
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Bai C, Zapata R, Karnati Y, Smail E, Hajduk AM, Gill TM, Ranka S, Manini TM, Mardini MT. Comparisons Between GPS-based and Self-reported Life-space Mobility in Older Adults. AMIA Annu Symp Proc 2023; 2022:212-220. [PMID: 37128363 PMCID: PMC10148377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Assessments of Life-space Mobility (LSM) evaluate the locations of movement and their frequency over a period of time to understand mobility patterns. Advancements in and miniaturization of GPS sensors in mobile devices like smartwatches could facilitate objective and high-resolution assessment of life-space mobility. The purpose of this study was to compare self-reported measures to GPS-based LSM extracted from 27 participants (44.4% female, aged 65+ years) who wore a smartwatch for 1-2 weeks at two different site locations (Connecticut and Florida). GPS features (e.g., excursion size/span) were compared to self-reported LSM with and without an indicator for needing assistance. Although correlations between self-reported measures and GPS-based LSM were positive, none were statistically significant. The correlations improved slightly when needing assistance was included, but statistical significance was achieved only for excursion size (r=0.40, P=0.04). The poor correlations between GPS-based and self-reported indicators suggest that they capture different dimensions of life-space mobility.
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Affiliation(s)
- Chen Bai
- University of Florida, Gainesville, Florida, USA
| | - Ruben Zapata
- University of Florida, Gainesville, Florida, USA
| | | | - Emily Smail
- University of Florida, Gainesville, Florida, USA
| | | | | | - Sanjay Ranka
- University of Florida, Gainesville, Florida, USA
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4
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Hajduk AM, Dodson JA, Murphy TE, Chaudhry SI. A risk model for decline in health status after acute myocardial infarction among older adults. J Am Geriatr Soc 2023; 71:1228-1235. [PMID: 36519774 PMCID: PMC10089939 DOI: 10.1111/jgs.18162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Health status is increasingly recognized as an important patient-centered outcome after acute myocardial infarction (AMI). Yet drivers of decline in health status after AMI remain largely unknown in older adults. We sought to develop and validate a predictive risk model for health status decline among older adult survivors of AMI. METHODS Using data from a prospective cohort study conducted from 2013 to 2017 of 3041 patients age ≥75 years hospitalized with acute myocardial infarction at 94 U.S. hospitals, we examined a broad array of demographic, clinical, functional, and psychosocial variables for their association with health status decline, defined as a decrease of ≥5 points in the Short Form-12 (SF-12) physical component score from hospitalization to 6 months post-discharge. Model selection was performed in logistic regression models of 20 imputed datasets to yield a parsimonious risk prediction model. Model discrimination and calibration were evaluated using c-statistics and calibration plots, respectively. RESULTS Of the 2571 participants included in the main analyses, 30% of patients experienced health status decline from hospitalization to 6 months post-discharge. The risk model contained 14 factors, 10 associated with higher risk of health status decline (age, pre-existing AMI, pre-existing cancer, pre-existing COPD, pre-existing diabetes, history of falls, presenting Killip class, acute kidney injury, baseline health status, and mobility impairment) and four associated with lower risk of health status decline (male sex, higher hemoglobin, receipt of revascularization, and arrhythmia during hospitalization). The model displayed good discrimination (c-statistic = 0.74 in validation cohort) and calibration (p > 0.05) in both development and validation cohorts. CONCLUSIONS We used split sampling to develop and validate a risk model for health status decline in older adults after hospitalization for AMI and identified several risk factors that may be modifiable to mitigate the threat of this important patient-centered outcome. External validation of this risk model is warranted.
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Affiliation(s)
- Alexandra M Hajduk
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - John A Dodson
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA
- Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Terrence E Murphy
- Department of Public Health Sciences, Penn State College of Medicine, State College, Pennsylvania, USA
| | - Sarwat I Chaudhry
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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5
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Cohen AB, McAvay GJ, Geda M, Chattopadhyay S, Lee S, Acampora D, Araujo K, Charpentier P, Gill TM, Hajduk AM, Ferrante LE. Rationale, Design, and Characteristics of the VALIANT (COVID-19 in Older Adults: A Longitudinal Assessment) Cohort. J Am Geriatr Soc 2023; 71:832-844. [PMID: 36544250 PMCID: PMC9877652 DOI: 10.1111/jgs.18146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 10/08/2022] [Accepted: 10/29/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Most older adults hospitalized with COVID-19 survive their acute illness. The impact of COVID-19 hospitalization on patient-centered outcomes, including physical function, cognition, and symptoms, is not well understood. To address this knowledge gap, we collected longitudinal data about these issues from a cohort of older survivors of COVID-19 hospitalization. METHODS We undertook a prospective study of community-living persons age ≥ 60 years who were hospitalized with COVID-19 from June 2020-June 2021. A baseline interview was conducted during or up to 2 weeks after hospitalization. Follow-up interviews occurred at one, three, and six months post-discharge. Participants completed comprehensive assessments of physical and cognitive function, symptoms, and psychosocial factors. An abbreviated assessment could be performed with a proxy. Additional information was collected from the electronic health record. RESULTS Among 341 participants, the mean age was 71.4 (SD 8.4) years, 51% were women, and 37% were of Black race or Hispanic ethnicity. Median length of hospitalization was 8 (IQR 6-12) days. All but 4% of participants required supplemental oxygen, and 20% required care in an intensive care unit or stepdown unit. At enrollment, nearly half (47%) reported at least one preexisting disability in physical function, 45% demonstrated cognitive impairment, and 67% were pre-frail or frail. Participants reported a mean of 9 of 14 (SD 3) COVID-19-related symptoms. At the six-month follow-up interview, more than a third of participants experienced a decline from their pre-hospitalization function, nearly 20% had cognitive impairment, and burdensome symptoms remained highly prevalent. CONCLUSIONS We enrolled a diverse cohort of older adults hospitalized with COVID-19 and followed them after discharge. Functional decline was common, and there were high rates of persistent cognitive impairment and symptoms. Future analyses of these data will advance our understanding of patient-centered outcomes among older COVID-19 survivors.
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Affiliation(s)
- Andrew B. Cohen
- Department of MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Gail J. McAvay
- Department of MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Mary Geda
- Department of MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Sumon Chattopadhyay
- Clinical and Translational Science InstituteUniversity of UtahSalt Lake CityUtahUSA
| | - Seohyuk Lee
- Department of MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Denise Acampora
- Department of MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Katy Araujo
- Department of MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Peter Charpentier
- Department of MedicineYale School of MedicineNew HavenConnecticutUSA
- CRI Web ToolsDurhamConnecticutUSA
| | - Thomas M. Gill
- Department of MedicineYale School of MedicineNew HavenConnecticutUSA
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6
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Moreines LT, Gettel CJ, Hajduk AM, Kukulka S, Lai JM, Ouellet JA. Emergency department clinician satisfaction with an APRN-led geriatric emergency medicine service consult team. J Am Geriatr Soc 2023; 71:991-994. [PMID: 36420709 PMCID: PMC10023295 DOI: 10.1111/jgs.18133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/21/2022] [Accepted: 11/01/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Laura T Moreines
- Rory Meyers College of Nursing, Hartford Institute for Geriatric Nursing, New York University, New York, New York, USA
| | - Cameron J Gettel
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale School of Medicine, Center for Outcomes Research and Evaluation, New Haven, Connecticut, USA
| | - Alexandra M Hajduk
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - James M Lai
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jennifer A Ouellet
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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7
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Demkowicz PC, Hajduk AM, Dodson JA, Oladele CR, Chaudhry SI. Racial disparities among older adults with acute myocardial infarction: The SILVER-AMI study. J Am Geriatr Soc 2023; 71:474-483. [PMID: 36415964 PMCID: PMC9957871 DOI: 10.1111/jgs.18084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 08/23/2022] [Accepted: 09/17/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Despite an aging population, little is known about racial disparities in aging-specific functional impairments and mortality among older adults hospitalized for acute myocardial infarction (AMI). METHODS We analyzed data from patients aged 75 years or older who were hospitalized for AMI at 94 US hospitals from 2013 to 2016. Functional impairments and geriatric conditions were assessed in-person during the AMI hospitalization. The association between race and risk of mortality (primary outcome) was evaluated with logistic regression adjusted sequentially for age, clinical characteristics, and measures of functional impairment and other conditions associated with aging. RESULTS Among 2918 participants, 2668 (91.4%) self-identified as White and 250 (8.6%) as Black. Black participants were younger (80.8 vs 81.7 years; p = 0.010) and more likely to be female (64.8% vs 42.5%; p < 0.001). Black participants were more likely to present with impairments in cognition (37.6% vs 14.5%; p < 0.001), mobility (66.0% vs 54.6%; p < 0.001) and vision (50.1% vs 35.7%; p < 0.001). Black participants were also more likely to report a disability in one or more activities of daily living (22.4% vs 13.0%; p < 0.001) and an unintentional loss of more than 10 lbs in the year prior to hospitalization (37.2% vs 13.0%; p < 0.001). The unadjusted odds of 6-month mortality among Black participants (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.4-2.8) attenuated to non-significance after adjustment for age, clinical characteristics (OR 1.70, 95% CI 1.7, 1.2-2.5), and functional/geriatric conditions (OR 1.5, 95% CI 1.0-2.2). CONCLUSIONS Black participants had a more geriatric phenotype despite a younger average age, with more functional impairments. Controlling for functional impairments and geriatric conditions attenuated disparities in 6-month mortality somewhat. These findings highlight the importance of systematically assessing functional impairment during hospitalization and also ensuring equitable access to community programs to support post-AMI recovery among Black older adults.
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Affiliation(s)
- Patrick C. Demkowicz
- Department of Internal Medicine, Section of General Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Alexandra M. Hajduk
- Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, Connecticut
| | - John A. Dodson
- Department of Medicine, Division of Cardiology, NYU Grossman School of Medicine, New York, New York
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Carol R. Oladele
- Department of Internal Medicine, Section of General Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- Equity Research and Innovation Center, Yale University School of Medicine, New Haven, Connecticut
| | - Sarwat I. Chaudhry
- Department of Internal Medicine, Section of General Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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Nguyen M, Chaudhry SI, Desai MM, Hajduk AM, McDade WA, Fancher TL, Boatright D. Rates of Medical Student Placement Into Graduate Medical Education by Sex, Race and Ethnicity, and Socioeconomic Status, 2018-2021. JAMA Netw Open 2022; 5:e2229243. [PMID: 36018592 PMCID: PMC9419015 DOI: 10.1001/jamanetworkopen.2022.29243] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This cohort study investigates whether different rates of medical student placement into graduate medical education exist by sex, race and ethnicity, and socioeconomic status from 2018 to 2021.
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Affiliation(s)
| | - Sarwat I. Chaudhry
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mayur M. Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Alexandra M. Hajduk
- Section of Geriatrics, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - William A. McDade
- Accrediation Council for Graduate Medical Education, Chicago, Illinois
| | - Tonya L. Fancher
- Division of General Internal Medicine, University of California, Davis, School of Medicine. Sacramento
| | - Dowin Boatright
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York
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9
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Falvey JR, Hajduk AM, Keys CR, Chaudhry SI. Association of Financial Strain With Mortality Among Older US Adults Recovering From an Acute Myocardial Infarction. JAMA Intern Med 2022; 182:445-448. [PMID: 35188537 PMCID: PMC8861896 DOI: 10.1001/jamainternmed.2021.8569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This cohort study explores the association of severe financial strain with elevated mortality risk following an acute myocardial infarction among US adults older than 75 years.
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Affiliation(s)
- Jason R Falvey
- Departments of Physical Therapy and Rehabilitation Science and Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Alexandra M Hajduk
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Sarwat I Chaudhry
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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10
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Goldstein DW, Hajduk AM, Song X, Tsang S, Geda M, McClurken JB, Tinetti ME, Krumholz HM, Chaudhry SI. Reply to: "Comment on: Falls in older adults after hospitalization for acute myocardial infarction". J Am Geriatr Soc 2022; 70:1880-1881. [PMID: 35332528 DOI: 10.1111/jgs.17742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/07/2022] [Indexed: 11/29/2022]
Affiliation(s)
- David W Goldstein
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alexandra M Hajduk
- Section of Geriatrics, Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Xuemei Song
- University of Texas Health, San Antonio, Texas, USA
| | - Sui Tsang
- Section of Geriatrics, Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Mary Geda
- Section of Geriatrics, Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - James B McClurken
- Department of Cardiothoracic Surgery, Doylestown Health, Doylestown, Pennsylvania, USA
| | - Mary E Tinetti
- Section of Geriatrics, Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Harlan M Krumholz
- Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, New Haven, Connecticut, United States.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Section of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA.,Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut, USA
| | - Sarwat I Chaudhry
- Section of General Internal Medicine, Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA
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11
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Lee YK, Fried TR, Costello DM, Hajduk AM, O'Leary JR, Cohen AB. Perceived dementia risk and advance care planning among older adults. J Am Geriatr Soc 2022; 70:1481-1486. [PMID: 35274737 PMCID: PMC9106856 DOI: 10.1111/jgs.17721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/12/2022] [Accepted: 01/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although advance care planning (ACP) is beneficial if dementia develops, and virtually all older adults are at risk for this disease, older adults do not consistently engage in ACP. Health behavior models have highlighted the importance of perceived susceptibility to medical conditions in motivating behavior. Following these models, we sought to determine how often older adults believe they are not at risk of developing dementia and to examine the association between perceived dementia risk and ACP participation. METHODS We performed a cross-sectional study of community-dwelling adults without cognitive impairment, aged ≥65 years, who were interviewed for the Health and Retirement Study in 2016 and asked about their perceived dementia risk (n = 711). Perceived dementia risk was ascertained with this question: "on a scale of 0 to 100, what is the percent chance that you will develop dementia sometime in the future?" We used multivariable-adjusted logistic regression to evaluate the association between perceived risk (0% versus >0%) and completion of a living will, appointment of a durable power of attorney for healthcare decisions, and discussion of treatment preferences. RESULTS Among respondents, 10.5% reported a perceived dementia risk of 0%. Perceived risk of 0% was associated with lower odds of completing a living will (OR 0.53; 95% CI, 0.30-0.93) and discussing treatment preferences (OR 0.51; 95% CI, 0.28-0.93) but not appointment of a durable power of attorney (OR 0.77; 95% CI, 0.42-1.39). Many respondents with perceived dementia risk >0% had not completed ACP activities, including a substantial minority of those with perceived risk >50%. CONCLUSIONS Older adults with no perceived dementia risk are less likely to participate in several forms of ACP, but the fact that many older adults with high levels of perceived risk had not completed ACP activities suggests that efforts beyond raising risk awareness are needed to increase engagement.
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Affiliation(s)
- Yu Kyung Lee
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Terri R Fried
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,VA Connecticut Health System, West Haven, Connecticut, USA
| | - Darcé M Costello
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Alexandra M Hajduk
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - John R O'Leary
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Andrew B Cohen
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,VA Connecticut Health System, West Haven, Connecticut, USA
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12
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Dodson JA, Schoenthaler A, Sweeney G, Fonceva A, Pierre A, Whiteson J, George B, Marzo K, Drewes W, Rerisi E, Mathew R, Aljayyousi H, Chaudhry SI, Hajduk AM, Gill TM, Estrin D, Kovell L, Jennings LA, Adhikari S. Rehabilitation Using Mobile Health for Older Adults With Ischemic Heart Disease in the Home Setting (RESILIENT): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e32163. [PMID: 35238793 PMCID: PMC8931649 DOI: 10.2196/32163] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/29/2021] [Accepted: 12/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background Participation in ambulatory cardiac rehabilitation remains low, especially among older adults. Although mobile health cardiac rehabilitation (mHealth-CR) provides a novel opportunity to deliver care, age-specific impairments may limit older adults’ uptake, and efficacy data are currently lacking. Objective This study aims to describe the design of the rehabilitation using mobile health for older adults with ischemic heart disease in the home setting (RESILIENT) trial. Methods RESILIENT is a multicenter randomized clinical trial that is enrolling patients aged ≥65 years with ischemic heart disease in a 3:1 ratio to either an intervention (mHealth-CR) or control (usual care) arm, with a target sample size of 400 participants. mHealth-CR consists of a commercially available mobile health software platform coupled with weekly exercise therapist sessions to review progress and set new activity goals. The primary outcome is a change in functional mobility (6-minute walk distance), which is measured at baseline and 3 months. Secondary outcomes are health status, goal attainment, hospital readmission, and mortality. Among intervention participants, engagement with the mHealth-CR platform will be analyzed to understand the characteristics that determine different patterns of use (eg, persistent high engagement and declining engagement). Results As of December 2021, the RESILIENT trial had enrolled 116 participants. Enrollment is projected to continue until October 2023. The trial results are expected to be reported in 2024. Conclusions The RESILIENT trial will generate important evidence about the efficacy of mHealth-CR among older adults in multiple domains and characteristics that determine the sustained use of mHealth-CR. These findings will help design future precision medicine approaches to mobile health implementation in older adults. This knowledge is especially important in light of the COVID-19 pandemic that has shifted much of health care to a remote, internet-based setting. Trial Registration ClinicalTrials.gov NCT03978130; https://clinicaltrials.gov/ct2/show/NCT03978130 International Registered Report Identifier (IRRID) DERR1-10.2196/32163
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Affiliation(s)
- John A Dodson
- Geriatric Cardiology Program, Medicine and Population Health, Leon H Charney Division of Cardiology, NYU Grossman School of Medicine, New York, NY, United States
| | - Antoinette Schoenthaler
- Department of Population Health, Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Greg Sweeney
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Ana Fonceva
- Leon H Charney Division of Cardiology, NYU Grossman School of Medicine, New York, NY, United States
| | - Alicia Pierre
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Jonathan Whiteson
- Department of Rehabilitation Medicine, Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Barbara George
- Division of Cardiology, Department of Medicine, NYU Long Island School of Medicine, Mineola, NY, United States
| | - Kevin Marzo
- Department of Medicine, Division of Cardiology, NYU Long Island School of Medicine, Mineola, NY, United States
| | - Wendy Drewes
- Division of Cardiology, NYU Langone Hospital Long Island, Mineola, NY, United States
| | - Elizabeth Rerisi
- Division of Cardiology, NYU Langone Hospital Long Island, Mineola, NY, United States
| | - Reena Mathew
- Division of Cardiology, NYU Langone Hospital Long Island, Mineola, NY, United States
| | - Haneen Aljayyousi
- Leon H Charney Division of Cardiology, NYU Grossman School of Medicine, New York, NY, United States
| | - Sarwat I Chaudhry
- Section of General Medicine, Yale University School of Medicine, New Haven, NY, United States
| | | | - Thomas M Gill
- Yale University School of Medicine, New Haven, CT, United States
| | - Deborah Estrin
- Cornell Tech and Weill Cornell Medicine, New York, NY, United States
| | - Lara Kovell
- Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, United States
| | - Lee A Jennings
- Reynolds Section of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Samrachana Adhikari
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
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13
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Brush JE, Hajduk AM, Greene EJ, Dreyer RP, Krumholz HM, Chaudhry SI. Sex Differences in Symptom Phenotypes Among Older Patients with Acute Myocardial Infarction. Am J Med 2022; 135:342-349. [PMID: 34715061 PMCID: PMC8901454 DOI: 10.1016/j.amjmed.2021.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Clinicians make a medical diagnosis by recognizing diagnostic possibilities, often using memories of prior examples. These memories, called "exemplars," reflect specific symptom combinations in individual patients, yet most clinical studies report how symptoms aggregate in populations. We studied how symptoms of acute myocardial infarction combine in individuals as symptom phenotypes and how symptom phenotypes are distributed in women and men. METHODS In this analysis of the SILVER-AMI Study, we studied 3041 patients (1346 women and 1645 men) 75 years of age or older with acute myocardial infarction. Each patient had a standardized in-person interview during the acute myocardial infarction admission to document the presenting symptoms, which enabled a thorough examination of symptom combinations in individuals. Specific symptom combinations defined symptom phenotypes and distributions of symptom phenotypes were compared in women and men using Monte Carlo permutation testing and repeated subsampling. RESULTS There were 1469 unique symptom phenotypes in the entire SILVER-AMI cohort of patients with acute myocardial infarction. There were 831 unique symptom phenotypes in women, as compared with 819 in men, which was highly significant, given the larger number of men than women in the study (P < .0001). Women had significantly more symptom phenotypes than men in almost all acute myocardial infarction subgroups. CONCLUSIONS Older patients with acute myocardial infarction have enormous variation in symptom phenotypes. Women reported more symptoms and had significantly more symptom phenotypes than men. Appreciation of the diversity of symptom phenotypes may help clinicians recognize the less common phenotypes that occur more often in women.
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Affiliation(s)
- John E Brush
- Sentara Healthcare and Eastern Virginia Medical School, Norfolk.
| | - Alexandra M Hajduk
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Erich J Greene
- Department of Health Policy and Management and Department of Biostatistics, Yale School of Medicine, New Haven, Conn
| | - Rachel P Dreyer
- Section of Cardiovascular Medicine, Department of Internal Medicine and Department of Emergency Medicine, Yale School of Medicine, New Haven, Conn; Yale School of Public Health; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn
| | - Harlan M Krumholz
- Department of Health Policy and Management and Department of Biostatistics, Yale School of Medicine, New Haven, Conn; Section of Cardiovascular Medicine, Department of Internal Medicine and Department of Emergency Medicine, Yale School of Medicine, New Haven, Conn; Yale School of Public Health; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn
| | - Sarwat I Chaudhry
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
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14
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Goldstein DW, Hajduk AM, Song X, Tsang S, Geda M, Dodson JA, Forman DE, Krumholz H, Chaudhry SI. Factors Associated With Cardiac Rehabilitation Participation in Older Adults After Myocardial Infarction: THE SILVER-AMI STUDY. J Cardiopulm Rehabil Prev 2022; 42:109-114. [PMID: 34799530 PMCID: PMC8881286 DOI: 10.1097/hcr.0000000000000627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Cardiac rehabilitation (CR) is a key aspect of secondary prevention following acute myocardial infarction (AMI). While there is growing evidence of unique benefits of CR in older adults, it remains underutilized. We aimed to examine specific demographic, clinical, and functional factors associated with utilization of CR among older adults hospitalized with AMI. METHODS Our project used data from the SILVER-AMI study, a nationwide prospective cohort study of patients age ≥75 yr hospitalized with AMI and followed them up for 6 mo after discharge. Extensive baseline data were collected on demographics, clinical and psychosocial factors, and functional and sensory impairments. The utilization of CR was collected by a survey at 6 mo. Backward selection was employed in a multivariable-adjusted logistic regression model to identify independent predictors of CR use. RESULTS Of the 2003 participants included in this analysis, 779 (39%) reported participating in CR within 6 mo of discharge. Older age, longer length of hospitalization, having ≤12 yr of education, visual impairment, cognitive impairment, and living alone were associated with decreased likelihood of CR participation; receipt of diagnostic and interventional procedures (ie, cardiac catheterization, percutaneous coronary intervention, and coronary artery bypass graft) was associated with increased likelihood of CR participation. CONCLUSIONS Demographic and clinical factors, as well as select functional and sensory impairments common in aging, were associated with CR participation at 6 mo post-discharge in older AMI patients. These results highlight opportunities to increase CR usage among older adults and identify those at risk for not participating.
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Affiliation(s)
- David W Goldstein
- Department of Internal Medicine, Massachusetts General Hospital, Boston (Dr Goldstein); Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut (Drs Hajduk, Krumholz, and Chaudhry and Mss Tsang and Geda); Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, Connecticut (Ms Song); Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York (Dr Dodson); Geriatric Cardiology Section, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Forman), and Section of Health Policy and Management, Yale School of Public Health, New Haven, and Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut (Dr Krumholz)
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15
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Goldstein DW, Hajduk AM, Song X, Tsang S, Geda M, McClurken JB, Tinetti ME, Krumholz HM, Chaudhry SI. Falls in older adults after hospitalization for acute myocardial infarction. J Am Geriatr Soc 2021; 69:3476-3485. [PMID: 34383963 DOI: 10.1111/jgs.17398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/24/2021] [Accepted: 07/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND After hospitalization for acute myocardial infarction (AMI), older adults may be at increased risk for falls due to deconditioning, new medications, and worsening health status. Our primary objective was to identify risk factors for falls after AMI hospitalization among adults over age 75. METHODS We used data from the Comprehensive Evaluation of Risk Factors in Older Patients with AMI (SILVER-AMI) study, a prospective cohort study of 3041 adults age 75 and older hospitalized with AMI at 94 community and academic medical centers across the United States. In-person interviews and physical assessments, as well as medical record review, were performed to collect demographic, clinical, functional, and psychosocial data. Falls were self-reported in telephone interviews and medically serious falls (those associated with emergency department use or hospitalization) were determined by medical record adjudication. Backward selection was used to identify predictors of fall risk in logistic regression analysis. RESULTS A total of 554 (21.6%) participants reported a fall and 191 (6.4%) had a medically serious fall within 6 months of discharge. Factors independently associated with self-reported falls included impaired mobility, prior fall history, longer hospital stay, visual impairment, and weak grip. Factors independently associated with medically serious falls included older age, polypharmacy, impaired functional mobility, prior fall history, and living alone. CONCLUSIONS Among older patients hospitalized for AMI, falls are common in the 6 months following discharge and associated with demographic, functional, and clinical factors that are readily identifiable. Fall risk should be considered in post-AMI clinical decision-making and interventions to prevent falls should be evaluated.
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Affiliation(s)
- David W Goldstein
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alexandra M Hajduk
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Xuemei Song
- University of Texas Health, San Antonio, Texas, USA
| | - Sui Tsang
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Mary Geda
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - James B McClurken
- Department of Cardiothoracic Surgery, Doylestown Health, Doylestown, Pennsylvania, USA
| | - Mary E Tinetti
- Section of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Section of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA.,Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut, USA
| | - Sarwat I Chaudhry
- Section of General Internal Medicine, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, United States
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16
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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; 134:910-917. [PMID: 33737057 PMCID: PMC8243828 DOI: 10.1016/j.amjmed.2021.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/12/2021] [Accepted: 03/01/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND While survival after acute myocardial infarction has improved substantially, older adults remain at heightened risk for hospital readmissions and death. Evidence for the role of cognitive impairment in older myocardial infarction survivors' risk for these outcomes is limited. METHODS 3041 patients aged ≥75 years hospitalized with acute myocardial infarction (mean age 82 ± 5 years, 56% male) recruited from 94 US hospitals. Cognition was assessed using the Telephone Interview for Cognitive Status; scores of <27 and <22 indicated mild and moderate/severe impairment, respectively. Readmissions and death at 6 months post-discharge were ascertained via participant report and medical record review. Associations between cognition 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, respectively. Readmission and death at 6 months occurred in 41% and 9% of participants, respectively. Mild and moderate/severe cognitive impairment were associated with increased risk of readmission (odds ratio [OR] 1.36; 95% confidence interval [CI], 1.08-1.72 and OR 1.58; 95% CI, 1.18-2.12, respectively) and death (OR 2.19; 95% CI, 1.54-3.11 and OR 3.82; 95% CI, 2.63-5.56, respectively) in unadjusted analyses. Significant associations between moderate/severe cognitive impairment and death (OR 1.69; 95% CI, 1.10-2.59) persisted after adjustment for demographics, myocardial infarction characteristics, comorbidity burden, functional status, and depression, 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.
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Affiliation(s)
- Alexandra M Hajduk
- Department of Internal Medicine, Yale School of Medicine, New Haven, Conn.
| | - Jane S Saczynski
- Department of Pharmacy and Health Systems Science, Northeastern School of Pharmacy, Boston, Mass
| | - Sui Tsang
- Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Mary E Geda
- Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - John A Dodson
- Leon H. Charney Division of Cardiology, Department of Medicine; Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine, New York, NY
| | - Gregory M Ouellet
- Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Sarwat I Chaudhry
- Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
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17
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Roy B, Hajduk AM, Tsang S, Geda M, Riley C, Krumholz HM, Chaudhry SI. The association of neighborhood walkability with health outcomes in older adults after acute myocardial infarction: The SILVER-AMI study. Prev Med Rep 2021; 23:101391. [PMID: 34040930 PMCID: PMC8141908 DOI: 10.1016/j.pmedr.2021.101391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/20/2021] [Accepted: 03/21/2021] [Indexed: 11/25/2022] Open
Abstract
Physical activity and social support are associated with better outcomes after surviving acute myocardial infarction (AMI), and greater walkability has been associated with activity and support. We used data from the SILVER-AMI study (November 2014–June 2017), a longitudinal cohort of community-living adults ≥ 75 years hospitalized for AMI to assess associations of neighborhood walkability with health outcomes, and to assess whether physical activity and social support mediate this relationship, if it exists. We included data from 1345 participants who were not bedbound, were discharged home, and for whom we successfully linked walkability scores (from Walk Score®) for their home census block. Our primary outcome was hospital-free survival time (HFST) at six months after discharge; secondary outcomes included physical and mental health at six months, assessed using SF-12. Physical activity and social support were measured at baseline. Covariates included cognition, functioning, comorbidities, participation in rehabilitation or physical therapy, and demographics. We employed survival analysis to examine associations between walkability and HFST, before and after adjustment for covariates; we repeated analyses using linear regression with physical and mental health as outcomes. In adjusted models, walkability was not associated with physical health (ß = 0.010; 95% CI: −0.027, 0.047), mental health (ß = −0.08; 95% CI: −0.175, −0.013), or HFST (ß = 0.008; 95% CI: −0.023, 0.009). Social support was associated with mental health in adjusted models. Neighborhood walkability was not predictive of outcomes among older adults with existing coronary disease, suggesting that among older adults, mobility limitations may supercede neighborhood walkability.
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Affiliation(s)
- Brita Roy
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, United States.,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States
| | - Alexandra M Hajduk
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Sui Tsang
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Mary Geda
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Carley Riley
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, United States.,Yale Center for Outcomes Research and Evaluation, Yale-New Haven Health, New Haven, CT, United States.,Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, United States
| | - Sarwat I Chaudhry
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, United States
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18
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Dodson JA, Hajduk AM, Murphy TE, Geda M, Krumholz HM, Tsang S, Nanna MG, Tinetti ME, Ouellet G, Sybrant D, Gill TM, Chaudhry SI. 180-day readmission risk model for older adults with acute myocardial infarction: the SILVER-AMI study. Open Heart 2021; 8:openhrt-2020-001442. [PMID: 33452007 PMCID: PMC7813425 DOI: 10.1136/openhrt-2020-001442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/11/2020] [Accepted: 12/13/2020] [Indexed: 12/29/2022] Open
Abstract
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.
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Affiliation(s)
- John A Dodson
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA .,Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Alexandra M Hajduk
- Geriatrics Section, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Terrence E Murphy
- Geriatrics Section, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mary Geda
- Geriatrics Section, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, Connecticut, USA.,Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | - Sui Tsang
- Geriatrics Section, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael G Nanna
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Mary E Tinetti
- Geriatrics Section, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Gregory Ouellet
- Geriatrics Section, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Deborah Sybrant
- International Heart Institute of Montana, Missoula, Montana, USA
| | - Thomas M Gill
- Geriatrics Section, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sarwat I Chaudhry
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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19
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Hajduk AM, Dodson JA, Murphy TE, Tsang S, Geda M, Ouellet GM, Gill TM, Brush JE, Chaudhry SI. Risk Model for Decline in Activities of Daily Living Among Older Adults Hospitalized With Acute Myocardial Infarction: The SILVER-AMI Study. J Am Heart Assoc 2020; 9:e015555. [PMID: 33000681 PMCID: PMC7792390 DOI: 10.1161/jaha.119.015555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background Functional decline (ie, a decrement in ability to perform everyday activities necessary to live independently) is common after acute myocardial infarction (AMI) and associated with poor long‐term outcomes; yet, we do not have a tool to identify older AMI survivors at risk for this important patient‐centered outcome. Methods and Results We used data from the prospective SILVER‐AMI (Comprehensive Evaluation of Risk Factors in Older Patients With Acute Myocardial Infarction) study of 3041 patients with AMI, aged ≥75 years, recruited from 94 US hospitals. Participants were assessed during hospitalization and at 6 months to collect data on demographics, geriatric impairments, psychosocial factors, and activities of daily living. Clinical variables were abstracted from the medical record. Functional decline was defined as a decrement in ability to independently perform essential activities of daily living (ie, bathing, dressing, transferring, and ambulation) from baseline to 6 months postdischarge. The mean age of the sample was 82±5 years; 57% were men, 90% were White, and 13% reported activity of daily living decline at 6 months postdischarge. The model identified older age, longer hospital stay, mobility impairment during hospitalization, preadmission physical activity, and depression as risk factors for decline. Revascularization during AMI hospitalization and ability to walk a quarter mile before AMI were associated with decreased risk. Model discrimination (c=0.78) and calibration were good. Conclusions We identified a parsimonious model that predicts risk of activity of daily living decline among older patients with AMI. This tool may aid in identifying older patients with AMI who may benefit from restorative therapies to optimize function after AMI.
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Affiliation(s)
| | - John A Dodson
- Leon H. Charney Division of Cardiology Department of Medicine New York University School of Medicine New York NY.,Division of Healthcare Delivery Science Department of Population Health New York University School of Medicine New York NY
| | - Terrence E Murphy
- Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Sui Tsang
- Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Mary Geda
- Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Gregory M Ouellet
- Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Thomas M Gill
- Department of Internal Medicine Yale School of Medicine New Haven CT
| | - John E Brush
- Sentara Healthcare and Eastern Virginia Medical School Norfolk VA
| | - Sarwat I Chaudhry
- Department of Internal Medicine Yale School of Medicine New Haven CT
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20
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Whitson HE, Hajduk AM, Song X, Geda M, Tsang S, Brush J, Chaudhry SI. Comorbid vision and cognitive impairments in older adults hospitalized for acute myocardial infarction. J Comorb 2020; 10:2235042X20940493. [PMID: 32728552 PMCID: PMC7366400 DOI: 10.1177/2235042x20940493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 11/30/2022]
Abstract
Older patients presenting with acute myocardial infarction (AMI) often have
comorbidities. Our objective was to examine how outcomes differ by cognitive and
vision status in older AMI patients. We use data from a prospective cohort study
conducted at 94 hospitals in the United States between January 2013 and October
2016 that enrolled men and women aged ≥75 years with AMI. Cognitive impairment
(CI) was defined as telephone interview for cognitive status (TICS) score
<27; vision impairment (VI) and activities of daily living (ADLs) were
assessed by questionnaire. Of 2988 senior AMI patients, 260 (8.7%) had CI but no
VI, 858 (28.7%) had VI but no CI, and 251 (8.4%) had both CI/VI. Patients in the
VI/CI group were most likely to exhibit geriatric syndromes. More severe VI was
associated with lower (worse) scores on the TICS (β −1.53, 95%
confidence interval (CI) −1.87 to −1.18). In adjusted models, compared to
participants with neither impairment, participants with VI/CI were more likely
to die (hazard ratio 1.61, 95% CI 1.10–2.37) and experience ADL decline (odds
ratio 2.11, 95% CI 1.39–3.21) at 180 days. Comorbid CIs and VIs were associated
with high rates of death and worsening disability after discharge among seniors
hospitalized for AMI. Future research should evaluate protocols to accommodate
these impairments during AMI presentations and optimize decision-making and
outcomes.
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Affiliation(s)
- Heather E Whitson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA.,Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA.,Geriatrics Research Education and Clinical Center, Durham Veterans Administration Medical Center, Durham, NC, USA
| | - Alexandra M Hajduk
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.,Yale University Program on Aging, New Haven, CT, USA
| | - Xuemei Song
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.,Yale University Program on Aging, New Haven, CT, USA
| | - Mary Geda
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.,Yale University Program on Aging, New Haven, CT, USA
| | - Sui Tsang
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.,Yale University Program on Aging, New Haven, CT, USA
| | | | - Sarwat I Chaudhry
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.,Yale University Program on Aging, New Haven, CT, USA
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21
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Mori M, Djulbegovic M, Hajduk AM, Holland ML, Krumholz HM, Chaudhry SI. Changes in Functional Status and Health-Related Quality of Life in Older Adults After Surgical, Interventional, or Medical Management of Acute Myocardial Infarction. Semin Thorac Cardiovasc Surg 2020; 33:72-81. [PMID: 32439546 DOI: 10.1053/j.semtcvs.2020.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 02/07/2023]
Abstract
Functional status and health-related quality of life (HRQoL) are important outcomes, particularly among older patients. However, data on such patient-centered outcomes after cardiac surgery are limited. We evaluated the incidence and predictors of decline in functional status and HRQoL among older patients hospitalized for acute myocardial infarction (AMI). Participants were age 75 years or older hospitalized for AMI at 94 US sites. We examined decline in functional status (defined as decline in 1 or more activities of daily living, ADLs), as well as mental (MCS) and physical component scales (PCS) of the SF-12 to assess HRQoL (5-point decline or greater in each scale) between 1 month prior to the hospitalization and 6 months after. Multivariable model compared the risk of decline after coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI) and medical management. Among 3041 patients (1708 PCI, 362 CABG, and 971 medical management), 1525 (50.2%) experienced decline in 1 or more domain: 633 (20.8%) declined in ADLs, 786 (25.9%) declined in the MCS, and 1078 (35.5%) declined in the PCS. The unadjusted incidence of ADL decline was the lowest among patients who underwent CABG (n = 50, 13.8%) compared with PCI (n = 271, 15.9%) or medical management (n = 312, 32.1%). Patients who underwent CABG and PCI had lower adjusted risk of decline in functional and HRQoL compared with those who received medical therapy. The risks after CABG and PCI were not significantly different. Over half of older patients significantly declined in function or HRQoL after AMI. Compared with medical management, risk of decline was lower in those who underwent revascularization.
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Affiliation(s)
- Makoto Mori
- Section of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
| | - Mia Djulbegovic
- National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut; Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Alexandra M Hajduk
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Sarwat I Chaudhry
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
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22
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Dodson JA, Hajduk AM, Murphy TE, Geda M, Krumholz HM, Tsang S, Nanna MG, Tinetti ME, Goldstein D, Forman DE, Alexander KP, Gill TM, Chaudhry SI. Thirty-Day Readmission Risk Model for Older Adults Hospitalized With Acute Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2020; 12:e005320. [PMID: 31010300 DOI: 10.1161/circoutcomes.118.005320] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Early readmissions among older adults hospitalized for acute myocardial infarction (AMI) are costly and difficult to predict. Aging-related functional impairments may inform risk prediction but are unavailable in most studies. Our objective was to, therefore, develop and validate an AMI readmission risk model for older patients who considered functional impairments and was suitable for use before hospital discharge. METHODS AND RESULTS SILVER-AMI (Comprehensive Evaluation of Risk in Older Adults with AMI) is a prospective cohort study of 3006 patients of age ≥75 years hospitalized with AMI at 94 US hospitals. Participants underwent in-hospital assessment of functional impairments including cognition, vision, hearing, and mobility. Other variables plausibly associated with readmissions were also collected. The outcome was all-cause readmission at 30 days. We used backward selection and Bayesian model averaging to derive (N=2004) a risk model that was subsequently validated (N=1002). Mean age was 81.5 years, 44.4% were women, and 10.5% were nonwhite. Within 30 days, 547 participants (18.2%) were readmitted. Readmitted participants were older, had more comorbidities, and had a higher prevalence of functional impairments, including activities of daily living disability (17.0% versus 13.0%; P=0.013) and impaired functional mobility (72.5% versus 53.6%; P<0.001). The final risk model included 8 variables: functional mobility, ejection fraction, chronic obstructive pulmonary disease, arrhythmia, acute kidney injury, first diastolic blood pressure, P2Y12 inhibitor use, and general health status. Functional mobility was the only functional impairment variable retained but was the strongest predictor. The model was well calibrated (Hosmer-Lemeshow P value >0.05) with moderate discrimination (C statistics: 0.65 derivation cohort and 0.63 validation cohort). Functional mobility significantly improved performance of the risk model (net reclassification improvement index =20%; P<0.001). CONCLUSIONS In our final risk model, functional mobility, previously not included in readmission risk models, was the strongest predictor of 30-day readmission among older adults after AMI. The modest discrimination indicates that much of the variability in readmission risk among this population remains unexplained by patient-level factors. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01755052.
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Affiliation(s)
- John A Dodson
- Leon H. Charney Division of Cardiology, Department of Medicine; Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine (J.A.D.)
| | - Alexandra M Hajduk
- Leon H. Charney Division of Cardiology, Department of Medicine; Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine (J.A.D.)
| | - Terrence E Murphy
- Leon H. Charney Division of Cardiology, Department of Medicine; Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine (J.A.D.)
| | - Mary Geda
- Leon H. Charney Division of Cardiology, Department of Medicine; Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine (J.A.D.)
| | - Harlan M Krumholz
- Leon H. Charney Division of Cardiology, Department of Medicine; Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine (J.A.D.)
| | - Sui Tsang
- Leon H. Charney Division of Cardiology, Department of Medicine; Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine (J.A.D.)
| | - Michael G Nanna
- Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.G.N., K.P.A.)
| | - Mary E Tinetti
- Leon H. Charney Division of Cardiology, Department of Medicine; Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine (J.A.D.)
| | - David Goldstein
- Leon H. Charney Division of Cardiology, Department of Medicine; Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine (J.A.D.)
| | - Daniel E Forman
- Section of Geriatric Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, PA (D.E.F.)
| | - Karen P Alexander
- Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.G.N., K.P.A.)
| | - Thomas M Gill
- Leon H. Charney Division of Cardiology, Department of Medicine; Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine (J.A.D.)
| | - Sarwat I Chaudhry
- Leon H. Charney Division of Cardiology, Department of Medicine; Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine (J.A.D.)
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23
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Richards BG, Hajduk AM, Perry J, Krumholz HM, Khan AM, Chaudhry SI. Patient-Reported Quality of Hospital Discharge Transitions: Results from the SILVER-AMI Study. J Gen Intern Med 2020; 35:808-814. [PMID: 31654359 PMCID: PMC7080904 DOI: 10.1007/s11606-019-05414-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Transitions from hospital to home in older patients are a high-risk period for adverse outcomes in a population that may have more challenges navigating the healthcare system. There is little information about the association of patient-reported quality of hospital discharge processes with clinical outcomes. OBJECTIVES We evaluated whether patient-reported quality of hospital discharge processes was associated with emergency department utilization and rehospitalization within 30 days of discharge after hospitalization for acute myocardial infarction (AMI) in older adults. DESIGN Multi-center, prospective cohort study. PATIENTS The ComprehenSIVe Evaluation of Risk Factors in Older Patients with Acute Myocardial Infarction (SILVER-AMI) study was a longitudinal study of 3006 adults age 75 and older hospitalized with AMI recruited from 94 academic and community hospitals from across the USA. INTERVENTION N/A MAIN MEASURES: Patients answered a subset of questions from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Readmissions and emergency department utilization within 30 days of discharge were ascertained through medical record review. KEY RESULTS A total of 2132 patients were included in the study. Patients' median age was 81 years and the response rate to the survey of discharge quality was 87%. Patients who reported being asked about having the help they needed at home were significantly less likely to have emergency room utilization within 30 days of discharge in both the unadjusted (0.65, 95% CI 0.43-0.99) and adjusted (0.65, 95% CI 0.42-0.997) models, though there was no significant association with readmission. CONCLUSION Report of an assessment of help needed at home during hospitalization was associated with lower post-discharge emergency department utilization. Efforts to improve outcomes after hospital discharge in older patients may benefit from greater focus on assessing need of help at home.
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Affiliation(s)
- Bradley G Richards
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
| | - Alexandra M Hajduk
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Julia Perry
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.,Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Ali M Khan
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA.,CareMore Health System, Cerritos, CA, USA.,Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Sarwat I Chaudhry
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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24
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Green YS, Hajduk AM, Song X, Krumholz HM, Sinha SK, Chaudhry SI. Usefulness of Social Support in Older Adults After Hospitalization for Acute Myocardial Infarction (from the SILVER-AMI Study). Am J Cardiol 2020; 125:313-319. [PMID: 31787249 DOI: 10.1016/j.amjcard.2019.10.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/23/2019] [Accepted: 10/29/2019] [Indexed: 01/14/2023]
Abstract
The availability of social support is associated with health outcomes after acute myocardial infarction (AMI), yet previous studies have largely considered social support as a single entity, rather than examining its discrete domains. Furthermore, few studies have investigated the impact of social support in older AMI patients, in whom it may be especially important. We aimed to determine the associations between 5 discrete domains of social support - emotional support, informational support, tangible support, positive social interaction, and affectionate support - with 6-month readmission and mortality in older patients hospitalized for AMI, adjusting for known predictors of post-AMI outcomes. Three thousand six participants 75 years and older were recruited from a network of 94 hospitals across the United States. A 5-item version of the Medical Outcomes Study Social Support Survey was used to measure perceived social support, and readmission and mortality were ascertained 6 months after initial hospitalization. Independent associations were determined using multivariable regression. Among 3,006 participants, mean age was 82 years, 44% were female, and 11% non-white. Participants who were female, non-white, less educated, and lived alone tended to report lower social support. In multivariable analyses, low informational support was associated with readmission (odds ratio 1.22; 95% confidence interval 1.01 to 1.47), and low emotional support with mortality (odds ratio 1.43; 95% confidence interval 1.04 to 1.97). In conclusion, individual domains of social support had distinct, independent associations with post-AMI outcomes, lending a more nuanced and precise understanding of this important social determinant of health. Understanding these distinct associations can inform the development of interventions and policies to improve post-AMI outcomes.
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Affiliation(s)
- Yaakov S Green
- Yale University School of Medicine, New Haven, Connecticut
| | - Alexandra M Hajduk
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
| | - Xuemei Song
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Samir K Sinha
- Departments of Medicine, Family and Community Medicine, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sarwat I Chaudhry
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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25
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Dodson JA, Hajduk AM, Geda M, Krumholz HM, Murphy TE, Tsang S, Tinetti ME, Nanna MG, McNamara R, Gill TM, Chaudhry SI. Predicting 6-Month Mortality for Older Adults Hospitalized With Acute Myocardial Infarction: A Cohort Study. Ann Intern Med 2020; 172:12-21. [PMID: 31816630 PMCID: PMC7695040 DOI: 10.7326/m19-0974] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Older adults with acute myocardial infarction (AMI) have higher prevalence of functional impairments, including deficits in cognition, strength, and sensory domains, than their younger counterparts. OBJECTIVE To develop and evaluate the prognostic utility of a risk model for 6-month post-AMI mortality in older adults that incorporates information about functional impairments. DESIGN Prospective cohort study. (ClinicalTrials.gov: NCT01755052). SETTING 94 hospitals throughout the United States. PARTICIPANTS 3006 persons aged 75 years or older who were hospitalized with AMI and discharged alive. MEASUREMENTS Functional impairments were assessed during hospitalization via direct measurement (cognition, mobility, muscle strength) or self-report (vision, hearing). Clinical variables associated with mortality in prior risk models were ascertained by chart review. Seventy-two candidate variables were selected for inclusion, and backward selection and Bayesian model averaging were used to derive (n = 2004 participants) and validate (n = 1002 participants) a model for 6-month mortality. RESULTS Participants' mean age was 81.5 years, 44.4% were women, and 10.5% were nonwhite. There were 266 deaths (8.8%) within 6 months. The final risk model included 15 variables, 4 of which were not included in prior risk models: hearing impairment, mobility impairment, weight loss, and lower patient-reported health status. The model was well calibrated (Hosmer-Lemeshow P > 0.05) and showed good discrimination (area under the curve for the validation cohort = 0.84). Adding functional impairments significantly improved model performance, as evidenced by category-free net reclassification improvement indices of 0.21 (P = 0.008) for hearing impairment and 0.26 (P < 0.001) for mobility impairment. LIMITATION The model was not externally validated. CONCLUSION A newly developed model for 6-month post-AMI mortality in older adults was well calibrated and had good discriminatory ability. This model may be useful in decision making at hospital discharge. PRIMARY FUNDING SOURCE National Heart, Lung, and Blood Institute of the National Institutes of Health.
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Affiliation(s)
- John A Dodson
- New York University School of Medicine, New York, New York (J.A.D.)
| | - Alexandra M Hajduk
- Yale School of Medicine, New Haven, Connecticut (A.M.H., M.G., T.E.M., S.T., M.E.T., T.M.G., S.I.C.)
| | - Mary Geda
- Yale School of Medicine, New Haven, Connecticut (A.M.H., M.G., T.E.M., S.T., M.E.T., T.M.G., S.I.C.)
| | - Harlan M Krumholz
- Yale New Haven Hospital, Yale School of Medicine, and Yale School of Public Health, New Haven, Connecticut (H.M.K.)
| | - Terrence E Murphy
- Yale School of Medicine, New Haven, Connecticut (A.M.H., M.G., T.E.M., S.T., M.E.T., T.M.G., S.I.C.)
| | - Sui Tsang
- Yale School of Medicine, New Haven, Connecticut (A.M.H., M.G., T.E.M., S.T., M.E.T., T.M.G., S.I.C.)
| | - Mary E Tinetti
- Yale School of Medicine, New Haven, Connecticut (A.M.H., M.G., T.E.M., S.T., M.E.T., T.M.G., S.I.C.)
| | - Michael G Nanna
- Duke University School of Medicine, Durham, North Carolina (M.G.N.)
| | | | - Thomas M Gill
- Yale School of Medicine, New Haven, Connecticut (A.M.H., M.G., T.E.M., S.T., M.E.T., T.M.G., S.I.C.)
| | - Sarwat I Chaudhry
- Yale School of Medicine, New Haven, Connecticut (A.M.H., M.G., T.E.M., S.T., M.E.T., T.M.G., S.I.C.)
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26
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Hajduk AM, Murphy TE, Geda ME, Dodson JA, Tsang S, Haghighat L, Tinetti ME, Gill TM, Chaudhry SI. Association Between Mobility Measured During Hospitalization and Functional Outcomes in Older Adults With Acute Myocardial Infarction in the SILVER-AMI Study. JAMA Intern Med 2019; 179:1669-1677. [PMID: 31589285 PMCID: PMC6784755 DOI: 10.1001/jamainternmed.2019.4114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/28/2019] [Indexed: 12/17/2022]
Abstract
Importance Many older survivors of acute myocardial infarction (AMI) experience functional decline, an outcome of primary importance to older adults. Mobility impairment has been proposed as a risk factor for functional decline but has not been evaluated to date in older patients hospitalized for AMI. Objective To examine the association of mobility impairment, measured during hospitalization, as a risk marker for functional decline among older patients with AMI. Design, Setting, and Participants Prospective cohort study among 94 academic and community hospitals in the United States. Participants were 2587 hospitalized patients with AMI who were 75 years or older. The study dates were January 2013 to June 2017. Main Outcomes and Measures Mobility was evaluated during AMI hospitalization using the Timed "Up and Go," with scores categorized as preserved mobility (≤15 seconds to complete), mild impairment (>15 to ≤25 seconds to complete), moderate impairment (>25 seconds to complete), and severe impairment (unable to complete). Self-reported function in activities of daily living (ADLs) (bathing, dressing, transferring, and walking around the home) and walking 0.4 km (one-quarter mile) was assessed at baseline and 6 months after discharge. The primary outcomes were worsening of 1 or more ADLs and loss of ability to walk 0.4 km from baseline to 6 months after discharge. The association between mobility impairment and risk of functional decline was evaluated with multivariable-adjusted logistic regression. Results Among 2587 hospitalized patients with AMI, the mean (SD) age was 81.4 (4.8) years, and 1462 (56.5%) were male. More than half of the cohort exhibited mobility impairment during AMI hospitalization (21.8% [564 of 2587] had mild impairment, 16.0% [414 of 2587] had moderate impairment, and 15.2% [391 of 2587] had severe impairment); 12.8% (332 of 2587) reported ADL decline, and 16.7% (431 of 2587) reported decline in 0.4-km mobility. Only 3.8% (30 of 800) of participants with preserved mobility experienced any ADL decline compared with 6.9% (39 of 564) of participants with mild impairment (adjusted odds ratio [aOR], 1.24; 95% CI, 0.74-2.09), 18.6% (77 of 414) of participants with moderate impairment (aOR, 2.67; 95% CI, 1.67-4.27), and 34.7% (136 of 391) of participants with severe impairment (aOR, 5.45; 95% CI, 3.29-9.01). Eleven percent (90 of 800) of participants with preserved mobility declined in ability to walk 0.4 km compared with 15.2% (85 of 558) of participants with mild impairment (aOR, 1.51; 95% CI, 1.04-2.20), 19.0% (78 of 411) of participants with moderate impairment (aOR, 2.03; 95% CI, 1.37-3.02), and 24.6% (95 of 386) of participants with severe impairment (aOR, 3.25; 95% CI, 2.02-5.23). Conclusions and Relevance This study's findings suggest that mobility impairment assessed during hospitalization may be a potent risk marker for functional decline in older survivors of AMI. These findings also suggest that brief, validated assessments of mobility should be part of the care of older hospitalized patients with AMI to identify those at risk for this important patient-centered outcome.
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Affiliation(s)
- Alexandra M. Hajduk
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Terrence E. Murphy
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mary E. Geda
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - John A. Dodson
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Sui Tsang
- Department of Medicine, NYU Langone Health, New York, New York
| | - Leila Haghighat
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mary E. Tinetti
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Thomas M. Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Sarwat I. Chaudhry
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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27
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Nanna MG, Hajduk AM, Krumholz HM, Murphy TE, Dreyer RP, Alexander KP, Geda M, Tsang S, Welty FK, Safdar B, Lakshminarayan DK, Chaudhry SI, Dodson JA. Sex-Based Differences in Presentation, Treatment, and Complications Among Older Adults Hospitalized for Acute Myocardial Infarction: The SILVER-AMI Study. Circ Cardiovasc Qual Outcomes 2019; 12:e005691. [PMID: 31607145 DOI: 10.1161/circoutcomes.119.005691] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Studies of sex-based differences in older adults with acute myocardial infarction (AMI) have yielded mixed results. We, therefore, sought to evaluate sex-based differences in presentation characteristics, treatments, functional impairments, and in-hospital complications in a large, well-characterized population of older adults (≥75 years) hospitalized with AMI. METHODS AND RESULTS We analyzed data from participants enrolled in SILVER-AMI (Comprehensive Evaluation of Risk Factors in Older Patients With Acute Myocardial Infarction)-a prospective observational study consisting of 3041 older patients (44% women) hospitalized for AMI. Participants were stratified by AMI subtype (ST-segment-elevation myocardial infarction [STEMI] and non-STEMI [NSTEMI]) and subsequently evaluated for sex-based differences in clinical presentation, functional impairments, management, and in-hospital complications. Among the study sample, women were slightly older than men (NSTEMI: 82.1 versus 81.3, P<0.001; STEMI: 82.2 versus 80.6, P<0.001) and had lower rates of prior coronary disease. Women in the NSTEMI subgroup presented less frequently with chest pain as their primary symptom. Age-associated functional impairments at baseline were more common in women in both AMI subgroups (cognitive impairment, NSTEMI: 20.6% versus 14.3%, P<0.001; STEMI: 20.6% versus 12.4%, P=0.001; activities of daily living disability, NSTEMI: 19.7% versus 11.4%, P<0.001; STEMI: 14.8% versus 6.4%, P<0.001; impaired functional mobility, NSTEMI: 44.5% versus 30.7%, P<0.001; STEMI: 39.4% versus 22.0%, P<0.001). Women with AMI had lower rates of obstructive coronary disease (NSTEMI: P<0.001; STEMI: P=0.02), driven by lower rates of 3-vessel or left main disease than men (STEMI: 38.8% versus 58.7%; STEMI: 24.3% versus 32.1%), and underwent revascularization less commonly (NSTEMI: 55.6% versus 63.6%, P<0.001; STEMI: 87.3% versus 93.3%, P=0.01). Rates of bleeding were higher among women with STEMI (26.2% versus 15.6%, P<0.001) but not NSTEMI (17.8% versus 15.7%, P=0.21). Women had a higher frequency of bleeding following percutaneous coronary intervention with both NSTEMI (11.0% versus 7.8%, P=0.04) and STEMI (22.6% versus 14.8%, P=0.02). CONCLUSIONS Among older adults hospitalized with AMI, women had a higher prevalence of age-related functional impairments and, among the STEMI subgroup, a higher incidence of overall bleeding events, which was driven by higher rates of nonmajor bleeding events and bleeding following percutaneous coronary intervention. These differences may have important implications for in-hospital and posthospitalization needs.
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Affiliation(s)
- Michael G Nanna
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (M.G.N., K.P.A.)
| | - Alexandra M Hajduk
- Department of Internal Medicine, Geriatrics Section, Program on Aging (A.H., T.E.M., M.G., S.T.), Yale School of Medicine, New Haven, CT
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT.,National Clinician Scholars Program, Department of Internal Medicine (H.M.K., S.I.C.), Yale School of Medicine, New Haven, CT.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.).,Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Terrence E Murphy
- Department of Internal Medicine, Geriatrics Section, Program on Aging (A.H., T.E.M., M.G., S.T.), Yale School of Medicine, New Haven, CT
| | - Rachel P Dreyer
- Department of Emergency Medicine, Center for Outcomes Research and Evaluation (R.P.D., B.S.), Yale School of Medicine, New Haven, CT
| | - Karen P Alexander
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (M.G.N., K.P.A.)
| | - Mary Geda
- Department of Internal Medicine, Geriatrics Section, Program on Aging (A.H., T.E.M., M.G., S.T.), Yale School of Medicine, New Haven, CT
| | - Sui Tsang
- Department of Internal Medicine, Geriatrics Section, Program on Aging (A.H., T.E.M., M.G., S.T.), Yale School of Medicine, New Haven, CT
| | - Francine K Welty
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (F.W., D.K.L.)
| | - Basmah Safdar
- Department of Emergency Medicine, Center for Outcomes Research and Evaluation (R.P.D., B.S.), Yale School of Medicine, New Haven, CT
| | - Dharshan K Lakshminarayan
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (F.W., D.K.L.)
| | - Sarwat I Chaudhry
- National Clinician Scholars Program, Department of Internal Medicine (H.M.K., S.I.C.), Yale School of Medicine, New Haven, CT.,Section of General Internal Medicine, Department of Internal Medicine (S.I.C.), Yale School of Medicine, New Haven, CT
| | - John A Dodson
- Leon H. Charney Division of Cardiology, Department of Medicine (J.A.D.), New York University School of Medicine.,Department of Population Health (J.A.D.), New York University School of Medicine
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Murphy TE, Tsang SW, Leo-Summers LS, Geda M, Kim DH, Oh E, Allore HG, Dodson J, Hajduk AM, Gill TM, Chaudhry SI. Bayesian Model Averaging for Selection of a Risk Prediction Model for Death within Thirty Days of Discharge: The SILVER-AMI Study. ACTA ACUST UNITED AC 2019; 8:1-7. [PMID: 31178945 PMCID: PMC6553647 DOI: 10.6000/1929-6029.2019.08.01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We describe a selection process for a multivariable risk prediction model of death within 30 days of hospital discharge in the SILVER-AMI study. This large, multi-site observational study included observational data from 2000 persons 75 years and older hospitalized for acute myocardial infarction (AMI) from 94 community and academic hospitals across the United States and featured a large number of candidate variables from demographic, cardiac, and geriatric domains, whose missing values were multiply imputed prior to model selection. Our objective was to demonstrate that Bayesian Model Averaging (BMA) represents a viable model selection approach in this context. BMA was compared to three other backward-selection approaches: Akaike information criterion, Bayesian information criterion, and traditional p-value. Traditional backward-selection was used to choose 20 candidate variables from the initial, larger pool of five imputations. Models were subsequently chosen from those candidates using the four approaches on each of 10 imputations. With average posterior effect probability ≥ 50% as the selection criterion, BMA chose the most parsimonious model with four variables, with average C statistic of 78%, good calibration, optimism of 1.3%, and heuristic shrinkage of 0.93. These findings illustrate the utility and flexibility of using BMA for selecting a multivariable risk prediction model from many candidates over multiply imputed datasets.
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Affiliation(s)
| | - Sui W Tsang
- Yale University School of Medicine, New Haven, CT, USA
| | | | - Mary Geda
- Yale University School of Medicine, New Haven, CT, USA
| | - Dae H Kim
- Harvard University School of Medicine, Boston, MA, USA
| | - Esther Oh
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - John Dodson
- New York University School of Medicine, New York, NY, USA
| | | | - Thomas M Gill
- Yale University School of Medicine, New Haven, CT, USA
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Hajduk AM, Gurwitz JH, Tabada G, Masoudi FA, Magid DJ, Greenlee RT, Sung SH, Cassidy-Bushrow AE, Liu TI, Reynolds K, Smith DH, Fiocchi F, Goldberg R, Gill TM, Gupta N, Peterson PN, Schuger C, Vidaillet H, Hammill SC, Allore H, Go AS. Influence of Multimorbidity on Burden and Appropriateness of Implantable Cardioverter-Defibrillator Therapies. J Am Geriatr Soc 2019; 67:1370-1378. [PMID: 30892695 DOI: 10.1111/jgs.15839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/25/2019] [Accepted: 01/26/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine whether burden of multiple chronic conditions (MCCs) influences the risk of receiving inappropriate vs appropriate device therapies. DESIGN Retrospective cohort study. SETTING Seven US healthcare delivery systems. PARTICIPANTS Adults with left ventricular systolic dysfunction receiving an implantable cardioverter-defibrillator (ICD) for primary prevention. MEASUREMENTS Data on 24 comorbid conditions were captured from electronic health records and categorized into quartiles of comorbidity burden (0-3, 4-5, 6-7 and 8-16). Incidence of ICD therapies (shock and antitachycardia pacing [ATP] therapies), including appropriateness, was collected for 3 years after implantation. Outcomes included time to first ICD therapy, total ICD therapy burden, and risk of inappropriate vs appropriate ICD therapy. RESULTS Among 2235 patients (mean age = 69 ± 11 years, 75% men), the median number of comorbidities was 6 (interquartile range = 4-8), with 98% having at least two comorbidities. During a mean 2.2 years of follow-up, 18.3% of patients experienced at least one appropriate therapy and 9.9% experienced at least one inappropriate therapy. Higher comorbidity burden was associated with an increased risk of first inappropriate therapy (adjusted hazard ratio [HR] = 1.94 [95% confidence interval {CI} = 1.14-3.31] for 4-5 comorbidities; HR = 2.25 [95% CI = 1.25-4.05] for 6-7 comorbidities; and HR = 2.91 [95% CI = 1.54-5.50] for 8-16 comorbidities). Participants with 8-16 comorbidities had a higher total burden of ICD therapy (adjusted relative risk [RR] = 2.12 [95% CI = 1.43-3.16]), a higher burden of inappropriate therapy (RR = 3.39 [95% CI = 1.67-6.86]), and a higher risk of receiving inappropriate vs appropriate therapy (RR = 1.74 [95% CI = 1.07-2.82]). Comorbidity burden was not significantly associated with receipt of appropriate ICD therapies. Patterns were similar when separately examining shock or ATP therapies. CONCLUSIONS In primary prevention ICD recipients, MCC burden was independently associated with an increased risk of inappropriate but not appropriate device therapies. Comorbidity burden should be considered when engaging patients in shared decision making about ICD implantation.
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Affiliation(s)
- Alexandra M Hajduk
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jerry H Gurwitz
- Meyers Primary Care Institute, a Joint Endeavor of University of Massachusetts Medical School, Fallon Health, and Reliant Medical Group, Worcester, Massachusetts
| | - Grace Tabada
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Frederick A Masoudi
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - David J Magid
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Robert T Greenlee
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Foundation, Marshfield, Wisconsin
| | - Sue Hee Sung
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | | | - Taylor I Liu
- Department of Cardiac Electrophysiology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - David H Smith
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Frances Fiocchi
- National Cardiovascular Data Registry, American College of Cardiology Foundation, Washington, DC
| | - Robert Goldberg
- Meyers Primary Care Institute, a Joint Endeavor of University of Massachusetts Medical School, Fallon Health, and Reliant Medical Group, Worcester, Massachusetts
| | - Thomas M Gill
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Nigel Gupta
- Department of Cardiac Electrophysiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Pamela N Peterson
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Claudio Schuger
- Heart and Vascular Institute, Henry Ford Health System, Detroit, Michigan
| | - Humberto Vidaillet
- Marshfield Clinical Research Foundation, Marshfield Clinic, Marshfield, Wisconsin
| | | | - Heather Allore
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, California.,Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, San Francisco, California.,Departments of Medicine, Health Research and Policy, Stanford University School of Medicine, Palo Alto, California
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30
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Hajduk AM, Hyde JE, Waring ME, Lessard DM, McManus DD, Fauth EB, Lemon SC, Saczynski JS. Practical Care Support During the Early Recovery Period After Acute Coronary Syndrome. J Appl Gerontol 2017; 37:881-903. [PMID: 28380706 DOI: 10.1177/0733464816684621] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the prevalence and predictors of receipt of practical support among acute coronary syndrome (ACS) survivors during the early post-discharge period. METHOD 406 ACS patients were interviewed about receipt of practical (instrumental and informational) support during the week after discharge. Demographic, clinical, functional, and psychosocial predictors of instrumental and informational practical support were examined. RESULTS 81% of participants reported receiving practical support during the early post-discharge period: 75% reported receipt of instrumental support and 51% reported receipt of informational support. Men were less likely to report receiving certain types of practical support, whereas married participants and those with higher education, impaired health literacy, impaired activities of daily living, and in-hospital complications were more likely to report receiving certain types of practical support. CONCLUSION Receipt of practical support is very common among ACS survivors during the early post-discharge period, and type of support received differs according to patient characteristics.
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31
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Layne AS, Hsu FC, Blair SN, Chen SH, Dungan J, Fielding RA, Glynn NW, Hajduk AM, King AC, Manini TM, Marsh AP, Pahor M, Pellegrini CA, Buford TW. Predictors of Change in Physical Function in Older Adults in Response to Long-Term, Structured Physical Activity: The LIFE Study. Arch Phys Med Rehabil 2016; 98:11-24.e3. [PMID: 27568165 DOI: 10.1016/j.apmr.2016.07.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/12/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To evaluate the extent of variability in functional responses in participants in the Lifestyle Interventions and Independence for Elders (LIFE) study and to identify the relative contributions of intervention adherence, physical activity, and demographic and health characteristics to this variability. DESIGN Secondary analysis. SETTING Multicenter institutions. PARTICIPANTS A volunteer sample (N=1635) of sedentary men and women aged 70 to 89 years who were able to walk 400m but had physical limitations, defined as a Short Physical Performance Battery (SPPB) score of ≤9. INTERVENTIONS Moderate-intensity physical activity (n=818) consisting of aerobic, resistance, and flexibility exercises performed both center-based (2times/wk) and home-based (3-4times/wk) sessions or health education program (n=817) consisting of weekly to monthly workshops covering relevant health information. MAIN OUTCOME MEASURES Physical function (gait speed over 400m) and lower extremity function (SPPB score) assessed at baseline and 6, 12, and 24 months. RESULTS Greater baseline physical function (gait speed, SPPB score) was negatively associated with change in gait speed (regression coefficient β=-.185; P<.001) and change in SPPB score (β=-.365; P<.001), whereas higher number of steps per day measured by accelerometry was positively associated with change in gait speed (β=.035; P<.001) and change in SPPB score (β=.525; P<.001). Other baseline factors associated with positive change in gait speed and/or SPPB score include younger age (P<.001), lower body mass index (P<.001), and higher self-reported physical activity (P=.002). CONCLUSIONS Several demographic and physical activity-related factors were associated with the extent of change in functional outcomes in participants in the LIFE study. These factors should be considered when designing interventions for improving physical function in older adults with limited mobility.
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Affiliation(s)
- Andrew S Layne
- Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL
| | - Fang-Chi Hsu
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Steven N Blair
- Department of Exercise Science, Department of Epidemiology/Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Shyh-Huei Chen
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - Roger A Fielding
- Nutrition, Exercise, Physiology, and Sarcopenia Laboratory, U.S. Department of Agriculture Jean Mayer Human Nutrition Research Center on Aging, Tufts University, Boston, MA
| | - Nancy W Glynn
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Alexandra M Hajduk
- Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, Yale University, New Haven, CT
| | - Abby C King
- Department of Health Research and Policy, School of Medicine, Stanford University, Palo Alto, CA
| | - Todd M Manini
- Department of Aging & Geriatric Research, University of Florida, Gainesville, FL
| | - Anthony P Marsh
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC
| | - Marco Pahor
- Department of Aging & Geriatric Research, University of Florida, Gainesville, FL
| | | | - Thomas W Buford
- Department of Aging & Geriatric Research, University of Florida, Gainesville, FL.
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Swede H, Hajduk AM, Sharma J, Rawal S, Rasool H, Vella AT, Tobet RE, Stevens RG. Baseline serum C-reactive protein and death from colorectal cancer in the NHANES III cohort. Int J Cancer 2013; 134:1862-70. [PMID: 24122448 DOI: 10.1002/ijc.28504] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 09/04/2013] [Indexed: 01/29/2023]
Abstract
Several prospective studies suggest that C-reactive protein (CRP), a nonspecific serologic marker of inflammation, might be linked to risk of colorectal cancer (CRC), whereas others have reported null or protective effects. We analyzed data from 7,072 participants (50-85 years) in the U.S. National Health and Nutrition Examination Survey III (1988-1994), a nationally representative cohort (n = 33,994; 2 months-85 years) with vital status follow-up to 2000. Hazard ratios (HRs) for mortality associated with baseline clinically raised (≥1.00 mg/dL) and intermediate (≥0.22-0.99 mg/dL) CRP levels were estimated using Cox proportional hazards regression controlling for CRC risk factors. There were 59 deaths from CRC, 106 from other obesity-related cancers (other-ORCs) and 1,130 from cardiovascular disease (CVD). Participants with clinically raised CRP at baseline were found to have a statistically significant greater risk of CRC death (HRs = 2.36-2.47) in comparison to persons with undetected levels. HRs were lower for death from other-ORC and CVD (1.82, 95% CI 1.05-3.15; 1.53, 95% CI 1.29-1.81, respectively). Intermediate CRP level was associated with a nonsignificant 10-21% increased risk for CRC death. HR for CRC death was higher among persons with a normal BMI (2.16, 95% 0.96-4.87, p = 0.06) compared to those who were overweight (1.22, 95% CI 0.53-2.78) or obese (1.23, 95% CI, 0.37-4.08). A similar pattern was observed for waist circumference. This effect modification suggests that the impact of chronic inflammation may be independent of excess body fat. Future research is recommended to confirm emerging data that elevated serologic CRP might reflect underlying colonic inflammation.
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Affiliation(s)
- Helen Swede
- Department of Community Medicine & Health Care, University of Connecticut Health Center, Farmington, CT
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Hajduk AM, Lemon SC, McManus DD, Lessard DM, Gurwitz JH, Spencer FA, Goldberg RJ, Saczynski JS. Cognitive impairment and self-care in heart failure. Clin Epidemiol 2013; 5:407-16. [PMID: 24187511 PMCID: PMC3810196 DOI: 10.2147/clep.s44560] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Heart failure (HF) is a prevalent chronic disease in older adults that requires extensive self-care to prevent decompensation and hospitalization. Cognitive impairment may impact the ability to perform HF self-care activities. We examined the association between cognitive impairment and adherence to self-care in patients hospitalized for acute HF. Design Prospective cohort study. Setting and participants A total of 577 patients (mean age = 71 years, 44% female) hospitalized for HF at five medical centers in the United States and Canada. Measurements and methods Participants were interviewed for information on self-reported adherence to self-care using the European Heart Failure Self-care Behaviour Scale. We assessed cognitive impairment in three domains (memory, processing speed, and executive function) using standardized measures. Patients’ demographic and clinical characteristics were obtained through medical record review. Multivariable linear regression was used to examine the association between cognitive impairment and self-care practices adjusting for demographic and clinical factors. Results A total of 453 patients (79%) were impaired in at least one cognitive domain. Average adherence to self-care activities among patients with global cognitive impairment did not differ significantly from those without cognitive impairment (30.5 versus 29.6; 45-point scale). However, impaired memory was associated with lower self-care scores (P = 0.006) in multivariable models. Conclusion Cognitive impairment is highly prevalent among older patients hospitalized for HF. Memory impairment is associated with poorer adherence to self-care practices. Screening for memory impairment in patients with HF may help to identify patients at risk for poor self-care who may benefit from tailored disease management programs.
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Affiliation(s)
- Alexandra M Hajduk
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA ; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA
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Abstract
BACKGROUND Cognitive impairment, highly prevalent in patients with heart failure (HF), increases risk for hospitalization and mortality. However, the course of cognitive change in HF is not well characterized. The purpose of this systematic review was to examine the available evidence longitudinal changes in cognitive function in patients with HF. METHODS AND RESULTS A literature search of several electronic databases was performed. Studies published from January 1, 1980, to September 30, 2012, that used validated measures to diagnose HF and assess cognitive function ≥2× in adults with HF were eligible for inclusion. Change in cognitive function was examined in the context of HF treatments applied (eg, medication initiation, left ventricular assist device implantation), length of follow-up, and comparison group. Fifteen studies met eligibility criteria. Significant decline in cognitive function was noted among patients with HF followed up for >1 year. Improvements in cognition were observed among patients with HF undergoing interventions to improve cardiac function (eg, heart transplantation) and among patients examined over short time periods (<1 year). Studies comparing patients' cognition over time with their own baseline tended to report improvements, whereas studies using a comparison group without HF tended to report declines or stability in cognition over time among patients with HF. CONCLUSIONS Patients with HF are at increased risk for cognitive decline, but this risk seems to be modifiable with cardiac treatment. Further research is needed to identify the mechanisms that cause cognitive changes in HF.
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Affiliation(s)
- Alexandra M Hajduk
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01655, USA.
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