根据认知状态评估老年急性心肌梗死患者的临床表现、治疗和结局：SILVER-AMI 研究。
Presentation, Treatment, and Outcomes of Older Adults Hospitalized for Acute Myocardial Infarction According to Cognitive Status: The SILVER-AMI Study.
机构信息
Department of Internal Medicine, Yale School of Medicine, New Haven, Conn.
Department of Pharmacy and Health Systems Science, Northeastern School of Pharmacy, Boston, Mass.
出版信息
Am J Med. 2021 Jul;134(7):910-917. doi: 10.1016/j.amjmed.2021.03.003. Epub 2021 Mar 15.
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.
背景
尽管急性心肌梗死患者的存活率有了显著提高，但老年人因再住院和死亡的风险仍居高不下。认知障碍在老年心肌梗死幸存者发生这些结局的风险中的作用证据有限。
方法
从美国 94 家医院招募了 3041 名年龄≥75 岁的急性心肌梗死住院患者（平均年龄 82±5 岁，56%为男性）。使用电话认知状态测试评估认知功能；得分<27 和<22 分别表示轻度和中重度/严重认知障碍。通过参与者报告和医疗记录审查来确定出院后 6 个月的再住院和死亡情况。使用多变量调整后的逻辑回归评估认知与结局之间的关联。
结果
该队列中分别有 11%和 6%的患者存在轻度和中重度/严重认知障碍。出院后 6 个月时，分别有 41%和 9%的患者发生再住院和死亡。轻度和中重度/严重认知障碍与再住院风险增加相关（比值比[OR] 1.36；95%置信区间[CI]，1.08-1.72 和 OR 1.58；95%CI，1.18-2.12），与死亡风险增加相关（OR 2.19；95%CI，1.54-3.11 和 OR 3.82；95%CI，2.63-5.56），在未调整分析中。中重度认知障碍与死亡（OR 1.69；95%CI，1.10-2.59）之间的显著关联在调整人口统计学、心肌梗死特征、合并症负担、功能状态和抑郁后仍然存在，但与再住院无关。
结论
在住院后几个月，中重度认知障碍与老年急性心肌梗死患者的死亡风险增加相关，但与再住院无关。常规认知筛查可能会识别出处于不良结局风险中的老年心肌梗死幸存者，他们可能受益于出院后更密切的监督和支持。
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