Physicians' Academy for Cardiovascular Education

Mobility impairment in older patients after AMI is associated with subsequent functional decline

Association Between Mobility Measured During Hospitalization and Functional Outcomes in Older Adults With Acute Myocardial Infarction in the SILVER-AMI Study

Literature - Hajduk AM, Murphy TE, Geda M et al., - JAMA Intern Med. 2019. doi:10.1001/jamainternmed.2019.4114

Introduction and methods

Over one-third of acute myocardial infarctions (AMIs) occur in persons of 75 years and older [1]. Survival after AMI in this age group has improved [2,3], but many face functional decline, such as loss of ability to independently perform everyday activities. Functional decline not only reduces independence and quality of life, it is also an omen of poor outcomes, such as readmissions [4], institutionalization [5] and mortality [6].

Little is known, however, about factors that put older adults at risk for functional decline after hospitalization for AMI. Evidence suggests that poor mobility is linked to higher mortality risk [7], frailty [8] and functional decline [9], but prior studies had limited generalizability or untimely collections of mobility data.

This prospective study in adults of 75 years and older therefore examined the association between mobility, assessed during AMI hospitalization and risk of functional decline at 6 months after discharge. The SILVER-AMI study [10] included 3041 older adults at 94 hospitals in the U.S. 454 Patients were lost to follow-up, leaving 2587 participants.

Mobility status was assessed during the baseline interview, by means of the Timed ‘Up and Go’ (TUG)[11], a performance-based assessment that has been validated for use in populations with cardiac concerns. Participants were also asked about their functioning 1 month before admission. To complete TUG, participants are asked to rise from a seated position, walk 3 m, turn, walk 3 m back to the chair and sit down. Use of assistive devices were allowed, but not help from a person. Time needed to complete TUG (in seconds) was used as the score. Mobility was categorized as preserved (≤15s), mild impairment (>15 to ≤25s), moderate impairment (>25s) and severe impairment (unable to complete assessment). This study assessed the effect of mobility impairment on the ability to independently perform 1 or more essential activities of daily living (ADLs) and ability to walk 0.4 km at 6 months after hospital discharge relative to premorbid functional status.

Main results


This multicenter, prospective study reveals that mobility impairment in elderly patients (>75 year) at the time of AMI hospitalization, as measured with TUG, is associated with higher risk of functional decline at 6 months after discharge. Several activities of daily living and neighborhood-level activity were affected. These findings suggest that TUG may serve as a useful ‘geriatric biomarker’ to identify older patients with AMI who are at risk for functional decline.


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Find this article online at JAMA Intern Med

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