FUNCTIONAL DISABILITY BEFORE MYOCARDIAL-INFARCTION IN THE ELDERLY AS A DETERMINANT OF INFARCTION SEVERITY AND POSTINFARCTION MORTALITY

Background: Functional disability is a common condition among elderly patients. However, to our knowledge, its effect on outcome of myocardi al infarction (MI) has not been assessed. Our objectives were to deter mine whether disability in the activities of daily living measured bef ore MI is a predictor of MI severity and mortality. Methods: Disabilit y in activities of daily living was measured prospectively in a cohort of 222 patients who were hospitalized with acute MI. Outcome measures were severity characteristics on admission to the hospital (higher Ki llip class, presence of new Q waves in the first electrocardiogram, an d lower systolic blood pressure), and 6-month mortality. Results: Pati ents with disability before hospitalization were older and had more co morbidity. After adjusting for these factors and for delay in hospital arrival, disability was still significantly associated with clinical severity on admission to the hospital and with mortality (adjusted rel ative risk of death for patients with disability vs patients without d isability, 2.01; 95% confidence interval, 1.23-3.28). Clinical severit y and hospital treatment explained the higher mortality of patients wi th disability. When these factors were added to the previous model, th e relative risk of mortality for patients with disability vs patients without disability was 1.24, and the 95% confidence interval was 0.73 to 2.12. Conclusions: Functional disability in activities of daily liv ing before MI is an important predictor of clinical severity and morta lity in elderly patients with MI. This effect is only minimally explai ned by the older age and higher comorbidity of patients with disabilit y. However, higher clinical severity and lower use of treatment interv entions are major determinants of their higher mortality compared with patients without disability.