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Open Access Research article

New potential determinants of disability in aged persons with myocardial infarction: results from the KORINNA-study

Philip Andrew Quinones12*, Hildegard Seidl3, Rolf Holle3, Bernhard Kuch45, Christa Meisinger12, Matthias Hunger3 and Inge Kirchberger12

Author Affiliations

1 Institute of Epidemiology II, Helmholtz-Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany

2 KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany

3 Institute of Health Economics and Health Care Management, Helmholtz-Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany

4 Department of Internal Medicine/Cardiology, Hospital of Nördlingen, Nördlingen, Germany

5 Department of Internal Medicine I – Cardiology, Central Hospital of Augsburg, Augsburg, Germany

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BMC Geriatrics 2014, 14:34  doi:10.1186/1471-2318-14-34

Published: 19 March 2014

Abstract

Background

Elderly individuals with coronary heart disease are a population particularly burdened by disability. However, to date many predictors of disability established in general populations have not been considered in studies examining disability in elderly acute myocardial infarction (AMI) survivors. Our study explores factors associated with the ability to perform basic activities of daily living in elderly patients with AMI.

Methods

Baseline data from 333 AMI-survivors older than 64 years included within the randomized controlled KORINNA-study were utilized to examine disability assessed by the Stanford Health Assessment Questionare Disability Index (HAQ-DI). Numerous potential determinants including demographic characteristics, clinical parameters, co-morbidities, interventions, lifestyle, behavioral and personal factors were measured.

Disability was defined as a HAQ-DI ≥ 0.5. After bi-variate testing the probability of disability was modeled with logistic regression. Missing covariate values were imputed using a Markov Chain Monte Carlo method.

Results

Disability was significantly more frequent in older individuals (Odds Ratio (OR): 1.10, 95% Confidence Interval (CI): 1.05-1.16), patients with deficient nutrition (OR: 3.38, 95% CI: 1.60-7.15), coronary artery bypass graft (CABG) (OR: 3.26, 95% CI: 1.29-8.25), hearing loss in both ears (OR: 2.85, 95% CI: 1.41-5.74), diabetes mellitus (OR: 2.56, 95% CI: 1.39-4.72), and heart failure (OR: 3.32, 95% CI: 1.79-6.16). It was reduced in patients with percutaneous transluminal coronary angioplasty (PTCA) (OR: 0.41, 95% CI: 0.21-0.80) and male sex (OR: 0.48, 95% CI: 0.27-0.85).

Conclusions

Effects of nutrition, hearing loss, and diametrical effects of PTCA and CABG on disability were identified as relevant for examination of causality in longitudinal trials.

Trial registration

ISRCTN02893746.

Keywords:
Myocardial infarction; Aged; Rehabilitation; Activities of daily living