Novel insights into treatment-related harms and functional decline among older adults with acute myocardial infarction.
Description: With the aging of the U.S. population there has been a fundamental shift among patients with acute myocardial infarction (AMI); the typical patient is now older, with more comorbidities, than even 20 years ago. Among patients age 75 or older, one of the most marked changes in AMI management has been use of coronary revascularization procedures, which have increased tenfold over the past decade. While older adults are known to be at high risk for treatment-related harms such as bleeding after PCI or renal failure after CABG, it remains challenging in practice to predict the risk for these harms. Physiologic age, which is manifested by 'geriatric impairments' in domains such as mobility, strength, and cognition, shows promise as a determinant of revascularization-related risk, but most studies have failed to measure it. While immediate procedural risk is important to patients, knowledge of long-term outcomes is critical as well; beyond mortality, functional decline is an important long-term outcome in older adults that may be precipitated by complications due to sequelae such as immobility from prolonged hospitalization. In this context, we propose to use the 2-year period for this mentored AHA award to study treatment-related harms and functional decline in older adults post-AMI, and whether decline can be prevented through an early post-discharge intervention. We will first analyze data from the SILVER-AMI study, an NIH-funded longitudinal cohort enrolling 3000 participants aged 75 or older with AMI (Aims 1-2), and subsequently will perform a pilot intervention (Aim 3). In Aim 1 we will develop risk scores for 30-day revascularization-related complications that incorporate geriatric impairments, while in Aim 2 we will analyze predictors of 6-month functional decline and the contribution of complications to this outcome. Subsequently, in Aim 3 we will perform a pilot intervention of home-based cardiac rehabilitation in patients from NYU Medical Center who are determined to be high-risk for decline at the time of AMI admission. The Sponsor for this award, Dr. Judith Hochman, is a well-known clinical trialist and AMI researcher who has an extensive track record of mentorship. Dr. Sarwat Chaudhry and Dr. Stuart Katz will serve as collaborators with expertise, respectively, in geriatric clinical epidemiology and exercise physiology. The proposed training plan will allow the Candidate to gain specific skills and transition to being an independent investigator.
Funder: American Heart Association
Amount: $153,400
Funding type: research
Funder scheme: Mentored Clinical & Population Research Program
Start date: 2016-01-01
End date: 2017-12-31
Investigators: John Dodson, John Dodson
Institution: NYU Grossman School of Medicine
Funded outputs count: 0
Funder award ID: 16MCPRP27020004
OpenAlex ID: G6599776545