Quinones Philip Andrew, Seidl Hildegard, Holle Rolf, Kuch Bernhard, Meisinger Christa, Hunger Matthias, Kirchberger Inge
Institute of Epidemiology II, Helmholtz-Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
BMC Geriatr. 2014 Mar 19;14:34. doi: 10.1186/1471-2318-14-34.
Elderly individuals with coronary heart disease are a population particularly burdened by disability. However, to date many predictors of disability established in general populations have not been considered in studies examining disability in elderly acute myocardial infarction (AMI) survivors. Our study explores factors associated with the ability to perform basic activities of daily living in elderly patients with AMI.
Baseline data from 333 AMI-survivors older than 64 years included within the randomized controlled KORINNA-study were utilized to examine disability assessed by the Stanford Health Assessment Questionare Disability Index (HAQ-DI). Numerous potential determinants including demographic characteristics, clinical parameters, co-morbidities, interventions, lifestyle, behavioral and personal factors were measured.Disability was defined as a HAQ-DI ≥ 0.5. After bi-variate testing the probability of disability was modeled with logistic regression. Missing covariate values were imputed using a Markov Chain Monte Carlo method.
Disability was significantly more frequent in older individuals (Odds Ratio (OR): 1.10, 95% Confidence Interval (CI): 1.05-1.16), patients with deficient nutrition (OR: 3.38, 95% CI: 1.60-7.15), coronary artery bypass graft (CABG) (OR: 3.26, 95% CI: 1.29-8.25), hearing loss in both ears (OR: 2.85, 95% CI: 1.41-5.74), diabetes mellitus (OR: 2.56, 95% CI: 1.39-4.72), and heart failure (OR: 3.32, 95% CI: 1.79-6.16). It was reduced in patients with percutaneous transluminal coronary angioplasty (PTCA) (OR: 0.41, 95% CI: 0.21-0.80) and male sex (OR: 0.48, 95% CI: 0.27-0.85).
Effects of nutrition, hearing loss, and diametrical effects of PTCA and CABG on disability were identified as relevant for examination of causality in longitudinal trials.
ISRCTN02893746.
冠心病老年患者是残疾负担尤为沉重的人群。然而，迄今为止，在研究老年急性心肌梗死（AMI）幸存者的残疾情况时，尚未考虑一般人群中已确定的许多残疾预测因素。我们的研究探讨了老年AMI患者日常生活基本活动能力的相关因素。
利用随机对照KORINNA研究中纳入的333名64岁以上AMI幸存者的基线数据，通过斯坦福健康评估问卷残疾指数（HAQ-DI）来评估残疾情况。测量了许多潜在的决定因素，包括人口统计学特征、临床参数、合并症、干预措施、生活方式、行为和个人因素。残疾定义为HAQ-DI≥0.5。在进行双变量测试后，用逻辑回归对残疾概率进行建模。使用马尔可夫链蒙特卡罗方法对缺失的协变量值进行插补。
残疾在老年人中更为常见（优势比（OR）：1.10，95%置信区间（CI）：1.05 - 1.16），营养不足的患者（OR：3.38，95%CI：1.60 - 7.15），冠状动脉旁路移植术（CABG）（OR：3.26，95%CI：1.29 - 8.25），双耳听力丧失（OR：2.85，95%CI：1.41 - 5.74），糖尿病（OR：2.56，95%CI：1.39 - 4.72）和心力衰竭（OR：3.32，95%CI：1.79 - 6.16）。经皮冠状动脉腔内血管成形术（PTCA）患者（OR：0.41，95%CI：0.21 - 0.80）和男性（OR：0.48，95%CI：0.27 - 0.85）的残疾情况有所减轻。
营养、听力丧失以及PTCA和CABG对残疾的截然相反影响被确定为纵向试验中因果关系研究的相关因素。
ISRCTN02893746。
