Nav: Home

Mobility may predict elderly heart attack survivors' repeat hospital stays

April 23, 2019

DALLAS, April 23, 2019 - Determining which elderly heart attack patients take longer to stand from a seated position and walk across a room may help predict who will be readmitted to the hospital within a month, according to new research in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.

Nearly 1 in 5 older adults hospitalized for heart attack is readmitted for heart failure, bleeding, irregular heart beat or other complications within 30 days of discharge, which is costly and detrimental to patients' quality of life.

"In general, there has been a lot of interest in preventing hospital readmissions among older patients within 30 days of discharge from the hospital, because of how common and costly they are," said study author John A. Dodson, M.D., M.P.H., assistant professor of Medicine and Population Health, and director of the NYU Geriatric Cardiology program in New York City. "Heart attack is one of the conditions specifically identified by Medicare as a priority for readmissions reduction, but so far it's been challenging to predict specifically which patients with heart attack will get readmitted."

In this study, researchers developed a first-of-its-kind prediction tool that considers functional impairments and traditional factors to identify which patients over age 75 may require repeat hospitalization.

Researchers analyzed data on 3,006 elderly heart patients (average age 81, 44 percent women, 10 percent nonwhite) in a study called ComprehenSIVe Evaluation of risk in Older Adults with AMI (SILVER-AMI) which enrolled participants from 94 U.S. hospitals. Participants underwent in-hospital assessment of functional impairments including cognition, vision, hearing and mobility. Functional mobility was based on the "Timed Up and Go" (TUG) assessment which timed how long it took to rise from a chair, walk 10 feet, then return to the chair.

Within 30 days, 547 participants (18.2 percent) were readmitted to a hospital. Researchers noted that impaired mobility, measured by how long it took to complete the TUG (or being unable to complete it at all), was the only functional impairment associated with 30-day readmission. Those who took longer than 25 seconds had nearly double the odds of readmission compared to those who completed it in less than 15 seconds. Other more traditional risk factors, including chronic lung disease and arrhythmias, were also associated with readmission.

"I think that impaired performance on the functional mobility test is a marker of generalized vulnerability to the stresses that can lead a patient to be readmitted to the hospital, such as infection, falls and recurrent cardiovascular events. There's considerable overlap between impaired mobility and something called the frailty syndrome, which is generally thought of as an increased vulnerability to these stresses," Dodson said.

The study excluded survivors with severe cognitive impairment or delirium; some eligible patients declined to participate; and patients in the SILVER AMI trial may be healthier than the general population - all factors that may limit the generalizability of the findings.

"There are other factors at play, such as performance of the health system, that are important in determining readmission risk," he said. "The findings will need to be replicated in future studies."

The study was coordinated by Yale University. Principal Investigator, Sarwat Chaudhry, M.D., noted that, "Given the aging of the population, there is growing interest in the role of functional impairments, such as those in mobility, cognition and muscle strength, in prognosis after major events such as heart attack. SILVER-AMI provides important evidence about how these impairments affect risk of readmission in older patients. Future studies from the SILVER data will provide information about mortality, falls and quality of life in this population."

An editorial by Michael W. Rich, MD notes that the study was limited to 30-day all cause readmissions which may not be relative to long term clinical outcomes, especially death. "Moreover, it fails to consider outcomes that are of greater import to older adults, such as physical and cognitive function, maintenance of independence, and quality of life. "

"We are facing a growing need to redesign healthcare delivery to meet the needs of this population. SILVER-AMI represents an important step forward in understanding the health status of older adults hospitalized with heart attack, as well as the factors that impact clinical outcomes," he wrote.
Other co-authors are Alexandra M. Hajduk, Ph.D., M.P.H.; Terrence E. Murphy, Ph.D.; Mary Geda, R.N., M.S.N.; Harlan M. Krumholz, M.D., M.S.; Sui Tsang, M.S.; Michael G. Nanna, M.D.; Mary E. Tinetti, M.D.; David Goldstein, B.S.; Daniel E. Forman, M.D.; Karen P. Alexander, M.D.; and Thomas M. Gill, M.D. No authors reported relevant disclosures.

The National Heart, Lung, and Blood Institute of the National Institutes of Health funded the study.

Additional Resources:

Available multimedia is on the right column of the release link -

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association's policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals. Foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations and health insurance providers are available at

About the American Heart Association

The American Heart Association is a leading force for a world of longer, healthier lives. With nearly a century of lifesaving work, the Dallas-based association is dedicated to ensuring equitable health for all. We are a trustworthy source empowering people to improve their heart health, brain health and well-being. We collaborate with numerous organizations and millions of volunteers to fund innovative research, advocate for stronger public health policies, and share lifesaving resources and information. Connect with us on, Facebook, Twitter or by calling 1-800-AHA-USA1.

American Heart Association

Related Heart Attack Articles:

Heart cells respond to heart attack and increase the chance of survival
The heart of humans and mice does not completely recover after a heart attack.
A simple method to improve heart-attack repair using stem cell-derived heart muscle cells
The heart cannot regenerate muscle after a heart attack, and this can lead to lethal heart failure.
Mount Sinai discovers placental stem cells that can regenerate heart after heart attack
Study identifies new stem cell type that can significantly improve cardiac function.
Fixing a broken heart: Exploring new ways to heal damage after a heart attack
The days immediately following a heart attack are critical for survivors' longevity and long-term healing of tissue.
Heart patch could limit muscle damage in heart attack aftermath
Guided by computer simulations, an international team of researchers has developed an adhesive patch that can provide support for damaged heart tissue, potentially reducing the stretching of heart muscle that's common after a heart attack.
How the heart sends an SOS signal to bone marrow cells after a heart attack
Exosomes are key to the SOS signal that the heart muscle sends out after a heart attack.
Heart attack patients taken directly to heart centers have better long-term survival
Heart attack patients taken directly to heart centers for lifesaving treatment have better long-term survival than those transferred from another hospital, reports a large observational study presented today at Acute Cardiovascular Care 2019, a European Society of Cardiology congress.
Among heart attack survivors, drug reduces chances of second heart attack or stroke
In a clinical trial involving 18,924 patients from 57 countries who had suffered a recent heart attack or threatened heart attack, researchers at the University of Colorado Anschutz Medical Campus and fellow scientists around the world have found that the cholesterol-lowering drug alirocumab reduced the chance of having additional heart problems or stroke.
Oxygen therapy for patients suffering from a heart attack does not prevent heart failure
Oxygen therapy does not prevent the development of heart failure.
I have had a heart attack. Do I need open heart surgery or a stent?
New advice on the choice between open heart surgery and inserting a stent via a catheter after a heart attack is launched today.
More Heart Attack News and Heart Attack Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

In & Out Of Love
We think of love as a mysterious, unknowable force. Something that happens to us. But what if we could control it? This hour, TED speakers on whether we can decide to fall in — and out of — love. Guests include writer Mandy Len Catron, biological anthropologist Helen Fisher, musician Dessa, One Love CEO Katie Hood, and psychologist Guy Winch.
Now Playing: Science for the People

#543 Give a Nerd a Gift
Yup, you guessed it... it's Science for the People's annual holiday episode that helps you figure out what sciency books and gifts to get that special nerd on your list. Or maybe you're looking to build up your reading list for the holiday break and a geeky Christmas sweater to wear to an upcoming party. Returning are pop-science power-readers John Dupuis and Joanne Manaster to dish on the best science books they read this past year. And Rachelle Saunders and Bethany Brookshire squee in delight over some truly delightful science-themed non-book objects for those whose bookshelves are already full. Since...
Now Playing: Radiolab

An Announcement from Radiolab