TY - JOUR T1 - 180-day readmission risk model for older adults with acute myocardial infarction: the SILVER-AMI study JF - Open Heart JO - Open Heart DO - 10.1136/openhrt-2020-001442 VL - 8 IS - 1 SP - e001442 AU - John A Dodson AU - Alexandra M Hajduk AU - Terrence E Murphy AU - Mary Geda AU - Harlan M Krumholz AU - Sui Tsang AU - Michael G Nanna AU - Mary E Tinetti AU - Gregory Ouellet AU - Deborah Sybrant AU - Thomas M Gill AU - Sarwat I Chaudhry Y1 - 2021/01/01 UR - http://openheart.bmj.com/content/8/1/e001442.abstract N2 - Objective To develop a 180-day readmission risk model for older adults with acute myocardial infarction (AMI) that considered a broad range of clinical, demographic and age-related functional domains.Methods We used data from ComprehenSIVe Evaluation of Risk in Older Adults with AMI (SILVER-AMI), a prospective cohort study that enrolled participants aged ≥75 years with AMI from 94 US hospitals. Participants underwent an in-hospital assessment of functional impairments, including cognition, vision, hearing and mobility. Clinical variables previously shown to be associated with readmission risk were also evaluated. The outcome was 180-day readmission. From an initial list of 72 variables, we used backward selection and Bayesian model averaging to derive a risk model (N=2004) that was subsequently internally validated (N=1002).Results Of the 3006 SILVER-AMI participants discharged alive, mean age was 81.5 years, 44.4% were women and 10.5% were non-white. Within 180 days, 1222 participants (40.7%) were readmitted. The final risk model included 10 variables: history of chronic obstructive pulmonary disease, history of heart failure, initial heart rate, first diastolic blood pressure, ischaemic ECG changes, initial haemoglobin, ejection fraction, length of stay, self-reported health status and functional mobility. Model discrimination was moderate (0.68 derivation cohort, 0.65 validation cohort), with good calibration. The predicted readmission rate (derivation cohort) was 23.0% in the lowest quintile and 65.4% in the highest quintile.Conclusions Over 40% of participants in our sample experienced hospital readmission within 180 days of AMI. Our final readmission risk model included a broad range of characteristics, including functional mobility and self-reported health status, neither of which have been previously considered in 180-day risk models.Data are available on reasonable request. Interested researchers can contact the senior author (SIC) for further information. ER -