Change in disability status as a predictor of long-term survival after myocardial infarction in the elderly

Seventy-five consecutive patients discharged from a geriatric medical ward after a proven myocardial infarction and still alive at three months were followed for three years. Twenty-two died. Sixty-five patients replied to a postal questionnaire designed to assess their degree of psychological impairment and disability sent at the end of the first and third month after discharge. The predictive value of an increased independency rating between the two administrations of the questionnaire for survival was 77%. The predictive value of a decreased independency rating for mortality was 52%. The only clinical feature noted on admission, whose frequency differed significantly between the group who died and those who survived, was a systolic blood pressure of 160 mmHg or more on admission but this was a less satisfactory predictor than change in disability status. Patients who improve their disability status in the few months after a myocardial infarction also have a low long-term mortality and can safely be excluded from out-patient follow-up.