Changes in Functional Status and Health-Related Quality of Life in Older Adults After Surgical, Interventional, or Medical Management of Acute Myocardial Infarction

• Published in: Seminars in thoracic and cardiovascular surgery 2021-01, Vol.33 (1), p.72-81
• Main Authors: Mori, Makoto, Djulbegovic, Mia, Hajduk, Alexandra M., Holland, Margaret L., Krumholz, Harlan M., Chaudhry, Sarwat I.
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Acute myocardial infarction; Aged; CABG; Coronary artery bypass graft; Coronary Artery Disease; Functional Status; Health-related quality of life; Humans; Myocardial Infarction - therapy; Older adults; Percutaneous Coronary Intervention - adverse effects; Quality of Life; Risk Factors; Treatment Outcome
• ISSN: 1043-0679; 1532-9488
• DOI: 10.1053/j.semtcvs.2020.05.001

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. [Display omitted]