The Influence of Age on Health Status After Acute Myocardial Infarction
The Influence of Age on Health Status After Acute Myocardial Infarction
Background: Older age is a risk factor for higher mortality after acute myocardial infarction (AMI), but the association with health status outcomes is largely unexplored.
Methods: In a prospective cohort of 2498 patients in the PREMIER study, we compared health-related quality of life (HRQL) and burden of angina symptoms among survivors of AMI by age strata (age groups ≥75, 65-74, 50-64, and 19-49 years) using the Seattle Angina Questionnaire. Multivariable analyses assessed the relationship between age and 1-year HRQL and angina burden, adjusting for differences in clinical characteristics, treatment, and baseline health status.
Results: Older patients comprised a majority: 20.1% were ≥75 years of age, 41.7% were 65 to 74 years of age, 20.7% were 50 to 64 years of age, and 17.4% were <50 years of age. At 12 months, older patients had higher mortality (17.0% vs 8.7% vs 6.1% vs 3.2% for age groups ≥75, 65-74, 50-64, 19-49; P < .001). Among survivors of AMI, increasing age was associated with less angina and better HRQL. By 12 months, older patients reported less angina (10.9% vs 12.7% vs 19.3% vs 23.4% for age groups ≥75, 65-74, 50-64, 19-49; P < .0001) and better HRQL (scores 89.1 vs 88.1 vs 82.5 vs 80.0, respectively; P < .0001), which persisted after adjustment for baseline angina, HRQL, and other demographic, clinical, disease severity, and treatment differences.
Conclusions: Although older patients have higher mortality after AMI, those who survive experience fewer symptoms and better HRQL at 1 year than younger patients. Angina remains present in a number of patients across the spectrum of age, supporting strategies to systematically assess and treat symptoms after AMI.
Increasing age has been consistently identified as a risk factor for mortality after acute myocardial infarction (AMI). Possible contributors to this risk include the general increasing comorbidity burden with age and the declining rates of treatment with guideline-recommended therapies, which are often underused in the most functionally limited patients. Just as older persons have a higher risk for death, it is also possible that older patients will experience more angina and poorer health-related quality of life (HRQL) after AMI. Yet, indirect evidence suggests that the opposite is plausible. For example, older patients with heart failure have better HRQL than younger patients despite greater functional limitation, possibly reflecting changing expectations of health status with advancing age. Despite the importance of HRQL and symptom burden outcomes to survivors of AMI, little is known about the patterns of health status outcomes as a function of age in the year after AMI.
Because AMI survival rates have improved, health status outcomes are relevant to a growing number of patients. Health status may be especially pertinent to older patients, who may focus more on symptom burden and quality of life than prolonging life. The Institute of Medicine and professional organizations have also emphasized the importance of patient centered care highlighting the value of understanding health status. However, given the clear relationship between higher mortality with age, clinicians may assume that older patients also have a greater likelihood of symptomatic and functional impairment, potentially encouraging therapeutic nihilism. A greater understanding of health status outcomes after AMI would allow patients and the clinicians caring for them to calibrate their expectations for successful recovery.
Accordingly, the objectives of this study were to assess health status outcomes, including angina frequency and HRQL, across the spectrum of age after AMI among patients enrolled in a large multicenter prospective cohort study. Specifically, we assessed patterns of health status outcomes over the 12 months after hospitalization among AMI survivors to elucidate the extent to which older patients may experience successful recovery after AMI.
Background: Older age is a risk factor for higher mortality after acute myocardial infarction (AMI), but the association with health status outcomes is largely unexplored.
Methods: In a prospective cohort of 2498 patients in the PREMIER study, we compared health-related quality of life (HRQL) and burden of angina symptoms among survivors of AMI by age strata (age groups ≥75, 65-74, 50-64, and 19-49 years) using the Seattle Angina Questionnaire. Multivariable analyses assessed the relationship between age and 1-year HRQL and angina burden, adjusting for differences in clinical characteristics, treatment, and baseline health status.
Results: Older patients comprised a majority: 20.1% were ≥75 years of age, 41.7% were 65 to 74 years of age, 20.7% were 50 to 64 years of age, and 17.4% were <50 years of age. At 12 months, older patients had higher mortality (17.0% vs 8.7% vs 6.1% vs 3.2% for age groups ≥75, 65-74, 50-64, 19-49; P < .001). Among survivors of AMI, increasing age was associated with less angina and better HRQL. By 12 months, older patients reported less angina (10.9% vs 12.7% vs 19.3% vs 23.4% for age groups ≥75, 65-74, 50-64, 19-49; P < .0001) and better HRQL (scores 89.1 vs 88.1 vs 82.5 vs 80.0, respectively; P < .0001), which persisted after adjustment for baseline angina, HRQL, and other demographic, clinical, disease severity, and treatment differences.
Conclusions: Although older patients have higher mortality after AMI, those who survive experience fewer symptoms and better HRQL at 1 year than younger patients. Angina remains present in a number of patients across the spectrum of age, supporting strategies to systematically assess and treat symptoms after AMI.
Increasing age has been consistently identified as a risk factor for mortality after acute myocardial infarction (AMI). Possible contributors to this risk include the general increasing comorbidity burden with age and the declining rates of treatment with guideline-recommended therapies, which are often underused in the most functionally limited patients. Just as older persons have a higher risk for death, it is also possible that older patients will experience more angina and poorer health-related quality of life (HRQL) after AMI. Yet, indirect evidence suggests that the opposite is plausible. For example, older patients with heart failure have better HRQL than younger patients despite greater functional limitation, possibly reflecting changing expectations of health status with advancing age. Despite the importance of HRQL and symptom burden outcomes to survivors of AMI, little is known about the patterns of health status outcomes as a function of age in the year after AMI.
Because AMI survival rates have improved, health status outcomes are relevant to a growing number of patients. Health status may be especially pertinent to older patients, who may focus more on symptom burden and quality of life than prolonging life. The Institute of Medicine and professional organizations have also emphasized the importance of patient centered care highlighting the value of understanding health status. However, given the clear relationship between higher mortality with age, clinicians may assume that older patients also have a greater likelihood of symptomatic and functional impairment, potentially encouraging therapeutic nihilism. A greater understanding of health status outcomes after AMI would allow patients and the clinicians caring for them to calibrate their expectations for successful recovery.
Accordingly, the objectives of this study were to assess health status outcomes, including angina frequency and HRQL, across the spectrum of age after AMI among patients enrolled in a large multicenter prospective cohort study. Specifically, we assessed patterns of health status outcomes over the 12 months after hospitalization among AMI survivors to elucidate the extent to which older patients may experience successful recovery after AMI.
