Design and rationale of the comprehensive evaluation of risk factors in older patients with AMI (SILVER-AMI) study
John A Dodson1, Mary Geda2, Harlan M Krumholz3,4,5,6
1Leon H Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, USA. John.Dodson@nyumc.org.
Insights
The SILVER-AMI study investigates risk factors for acute myocardial infarction (AMI) in adults 75 and older. It aims to improve risk assessment by including geriatric impairments for better patient outcomes.
Area of Science:
- Cardiology
- Geriatric Medicine
- Clinical Research
Background:
- Older adults (75+) are a growing demographic for acute myocardial infarction (AMI) but are underrepresented in research.
- Chronological age increases AMI risk, but risk heterogeneity and specific factors in this population are not well understood.
- Geriatric impairments like muscle weakness and cognitive decline may significantly impact AMI outcomes.
Purpose of the Study:
- To evaluate risk factors for hospital readmission, mortality, and health status decline in older adults post-AMI.
- To address knowledge gaps regarding the heterogeneity of risk in elderly patients with AMI.
- To incorporate geriatric assessments into understanding post-AMI outcomes for personalized risk stratification.
Main Methods:
- Prospective cohort study enrolling 3000 older adults hospitalized with AMI across ~70 US hospitals.
- Comprehensive in-hospital assessments including clinical data, geriatric impairments, and health status.
- Six-month follow-up to assess hospital readmission, mortality, and health status decline; multivariable regression for risk modeling.
Main Results:
- Data collection and analysis are ongoing.
- Risk models for post-AMI outcomes in older adults are being developed.
- The study will identify key predictors of adverse events in this population.
Conclusions:
- The SILVER-AMI study will significantly enhance understanding of AMI in older patients.
- Incorporating geriatric impairments is crucial for personalized risk assessment and targeted interventions.
- Findings aim to improve care and outcomes for elderly individuals following an AMI.
Background:
While older adults (age 75 and over) represent a large and growing proportion of patients with acute myocardial infarction (AMI), they have traditionally been under-represented in cardiovascular studies. Although chronological age confers an increased risk for adverse outcomes, our current understanding of the heterogeneity of this risk is limited. The Comprehensive Evaluation of Risk Factors in Older Patients with AMI (SILVER-AMI) study was designed to address this gap in knowledge by evaluating risk factors (including geriatric impairments, such as muscle weakness and cognitive impairments) for hospital readmission, mortality, and health status decline among older adults hospitalized for AMI.
Methods/Design:
SILVER-AMI is a prospective cohort study that is enrolling 3000 older adults hospitalized for AMI from a recruitment network of approximately 70 community and academic hospitals across the United States. Participants undergo a comprehensive in-hospital assessment that includes clinical characteristics, geriatric impairments, and health status measures. Detailed medical record abstraction complements the assessment with diagnostic study results, in-hospital procedures, and medications. Participants are subsequently followed for six months to determine hospital readmission, mortality, and health status decline. Multivariable regression will be used to develop risk models for these three outcomes.
Discussion:
SILVER-AMI will fill critical gaps in our understanding of AMI in older patients. By incorporating geriatric impairments into our understanding of post-AMI outcomes, we aim to create a more personalized assessment of risk and identify potential targets for interventions.
Trial Registration Number:
NCT01755052 .
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