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



      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.


      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.


      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.


      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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        • Kozak L
        • DeFrances C
        • Hall M.
        National hospital discharge survey: 2004 annual summary with detailed diagnosis and procedure data.
        Vital Health Stat 13. 2006; 162: 1-209
        • Roger VL
        • Go AS
        • Lloyd-Jones DM
        • et al.
        Heart disease and stroke statistics–2012 update: a report from the American Heart Association.
        Circulation. 2012; 125: e2-e220
        • Saunderson CED
        • RA Brogan
        • Simms AD
        • Sutton G
        • Batin PD
        • Gale CP
        Acute coronary syndrome management in older adults: guidelines, temporal changes and challenges.
        Age Ageing. 2014; 43: 450-455
        • Krumholz HM
        • Chen J
        • Chen YT
        • Wang Y
        • Radford MJ.
        Predicting one-year mortality among elderly survivors of hospitalization for an acute myocardial infarction: results from the Cooperative Cardiovascular Project.
        J Am Coll Cardiol. 2001; 38: 453-459
        • Dodson JA
        • Hajduk AM
        • Murphy TE
        • et al.
        Thirty-day readmission risk model for older adults hospitalized with acute myocardial infarction.
        Circ Cardiovasc Qual Outcomes. 2019; 12e005320
        • Dodson JA
        • Hajduk AM
        • Geda M
        • et al.
        Predicting 6-month mortality for older adults hospitalized with acute myocardial infarction.
        Ann Intern Med. 2020; 172: 12-21
        • Gharacholou SM
        • Reid KJ
        • Arnold SV
        • et al.
        Cognitive impairment and outcomes in older adult survivors of acute myocardial infarction: findings from the translational research investigating underlying disparities in acute myocardial infarction patients’ health status registry.
        Am Heart J. 2011; 162: 860-869.e1
        • Gu SZ
        • Beska B
        • Chan D
        • et al.
        Cognitive decline in older patients with non-ST elevation acute coronary syndrome.
        J Am Heart Assoc. 2019; 8e011218
        • Gasquoine PG.
        Cognitive impairment in common, noncentral nervous system medical conditions of adults and the elderly.
        J Clin Exp Neuropsychol. 2011; 33: 486-496
        • Krumholz H.
        Post-hospital syndrome-an acquired, transient condition of generalized risk.
        N Engl J Med. 2013; 368: 100-102
        • Riegel B
        • Moser DK
        • Buck HG
        • et al.
        Self-care for the prevention and management of cardiovascular disease and stroke.
        J Am Heart Assoc. 2017; 6e006997
        • O'Donnell M
        • Teo K
        • Gao P
        • et al.
        Cognitive impairment and risk of cardiovascular events and mortality.
        Eur Heart J. 2012; 33: 1777-1786
        • Bagai A
        • Chen AY
        • Udell JA
        • et al.
        Association of cognitive impairment with treatment and outcomes in older myocardial infarction patients: a report from the NCDR Chest Pain-MI Registry.
        J Am Heart Assoc. 2019; 8e012929
        • Levine DA
        • Langa KM
        • Galecki A
        • et al.
        Mild cognitive impairment and receipt of treatments for acute myocardial infarction in older adults.
        J Gen Intern Med. 2020; 35: 28-35
        • Dodson JA
        • Geda M
        • Krumholz HM
        • et al.
        Design and rationale of the comprehensive evaluation of risk factors in older patients with AMI (SILVER-AMI) study.
        BMC Health Serv Res. 2014; 14: 506
        • Thygesen K
        • Alpert JS
        • Jaffe AS
        • et al.
        Third universal definition of myocardial infarction.
        Eur Heart J. 2012; 33: 2551-2567
        • Jeste DV
        • Palmer BW
        • Appelbaum PS
        • et al.
        A new brief instrument for assessing decisional capacity for clinical research.
        Arch Gen Psychiatry. 2007; 64: 966-974
        • Brandt J
        • Spencer M
        • Folstein M.
        The telephone interview for cognitive status.
        Neuropsychiatry Neuropsychol Behav Neurol. 1988; 1: 111-117
        • Moylan T
        • Das K
        • Gibb A
        • et al.
        Assessment of cognitive function in older hospital inpatients: is the Telephone Interview for Cognitive Status (TICS-M) a useful alternative to the Mini Mental State Examination?.
        Int J Geriatr Psychiatry. 2004; 19: 1008-1009
        • Seo EH
        • Lee DY
        • Kim SG
        • et al.
        Validity of the telephone interview for cognitive status (TICS) and modified TICS (TICSm) for mild cognitive imparment (MCI) and dementia screening.
        Arch Gerontol Geriatr. 2011; 52: e26-e30
        • Fong TG
        • Fearing MA
        • Jones RN
        • et al.
        Telephone Interview for Cognitive Status: creating a crosswalk with the Mini-Mental State Examination.
        Alzheimer's Dement. 2009; 5: 492-497
        • Chodosh J
        • Petitti DB
        • Elliott M
        • et al.
        Physician recognition of cognitive impairment: evaluating the need for improvement.
        J Am Geriatr Soc. 2004; 52: 1051-1059
        • Torisson G
        • Minthon L
        • Stavenow L
        • Londos E.
        Cognitive impairment is undetected in medical inpatients: a study of mortality and recognition amongst healthcare professionals.
        BMC Geriatr. 2012; 12: 47
        • Robertson DA
        • Savva GM
        • Kenny RA.
        Frailty and cognitive impairment–a review of the evidence and causal mechanisms.
        Ageing Res Rev. 2013; 12: 840-851
        • Callahan KE
        • Lovato JF
        • Miller ME
        • Easterling D
        • Snitz B
        • Williamson JD.
        Associations between mild cognitive impairment and hospitalization and readmission.
        J Am Geriatr Soc. 2015; 63: 1880-1885
        • Briet C
        • Blanchart K
        • Lemaître A
        • et al.
        Bedside mental status and outcome in elderly patients admitted for acute coronary syndromes.
        Heart. 2019; 105: 1635-1641
        • Hajduk AM
        • Murphy TE
        • Geda ME
        • et al.
        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
        • Goldberg RJ
        • Saczynski JS
        • McManus DD
        • et al.
        Characteristics of contemporary patients discharged from the hospital after an acute coronary syndrome.
        Am J Med. 2015; 128: 1087-1093
        • Nasreddine ZS
        • Phillips NA
        • Bédirian V
        • et al.
        The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment.
        J Am Geriatr Soc. 2005; 53: 695-699
        • Wittich W
        • Phillips N
        • Nasreddine ZS
        • Chertkow H.
        Sensitivity and specificity of the Montreal cognitive assessment modified for individuals who are visually impaired.
        J Vis Impair Blind. 2010; 104: 360-368
        • Lowenstern A
        • Wang TY.
        Rethinking cognitive impairment in the management of older patients with cardiovascular disease.
        J Am Heart Assoc. 2019; 8e011968
        • Groff AC
        • Colla CH
        • Lee TH.
        Days spent at home — a patient-centered goal and outcome.
        N Engl J Med. 2016; 375: 1610-1612
        • Fried TR
        • Tinetti M
        • Agostini J
        • Iannone L
        • Towle V.
        Health outcome prioritization to elicit preferences of older persons with multiple health conditions.
        Patient Educ Couns. 2011; 83: 278-282