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. 2022 Dec;45(12):1277-1286.
doi: 10.1002/clc.23915. Epub 2022 Nov 1.

Multimorbidity, functional impairment, and mortality in older patients stable after prior acute myocardial infarction: Insights from the TIGRIS registry

Akshay Bagai  1 , Faeez M Ali  1 , John Gregson  2 , Karen P Alexander  3 , Mauricio G Cohen  4 , Karolina Andersson Sundell  5 , Tabassome Simon  6   7 , Dirk Westermann  8 , Satoshi Yasuda  9 , David Brieger  10 , Shaun G Goodman  1   11 , Jose C Nicolau  12 , Christopher B Granger  13 , Stuart Pocock  2
Affiliations

Multimorbidity, functional impairment, and mortality in older patients stable after prior acute myocardial infarction: Insights from the TIGRIS registry

Akshay Bagai et al. Clin Cardiol. 2022 Dec.

Abstract

Background: Data on the association of multimorbidity and functional impairment with cardiovascular (CV) and non-CV outcomes among older myocardial infarction (MI) patients are limited.

Hypothesis: Multimorbidity and functional impairment among older MI patients are associated with CV and non-CV mortality.

Methods: Patients aged ≥65 years, 1-3 years post-MI, and enrolled between June 2013 and Novemeber 2014 from 349 sites in 25 countries in the global TIGRIS registry were categorized by age, number of comorbidities, and presence and degree of functional impairment. Functional impairment was calculated using five-dimension EuroQol based on three domains-mobility, self-care, and usual activities. The association between age, number of comorbid conditions, and degree of functional impairment with 2-year incidence of CV and non-CV death was evaluated using Poisson regression analysis.

Results: Older age was associated with higher number of comorbidities and functional impairment; after adjustment, increasing age was significantly associated with non-CV mortality (p = .03) but not CV mortality (p = .38). Greater functional impairment was associated with a higher rate and relatively equal magnitude risk of CV (rate ratios [RR] 1.52, 95% confidence intervals [CI]: 1.29-1.79, per one-step increase) and non-CV mortality (RR 1.42, 95% CI: 1.17-1.73). Multimorbidity was more strongly associated with CV mortality (RR 1.52, 95% CI: 1.38-1.67, per additional comorbidity) versus non-CV mortality (RR 1.29, 95% CI: 1.14-1.47, per additional comorbidity).

Conclusions: Multimorbidity and functional impairment are prevalent among older post-MI patients and are associated with increased CV and non-CV mortality. These findings highlight the importance of considering comorbid conditions and functional impairment as predictors of risk for adverse outcomes and aspects of medical decision making. Clinical Trial Registration: NCT01866904.

Keywords: Acute coronary syndromes; comorbidities; frailty; functional impairment; multimorbidity; myocardial infarction; older age; outcomes; rehabilitation; stroke.

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Conflict of interest statement

A. B. has received speaker/consulting honoraria from AstraZeneca, Bayer Inc, Servier, Bristol Myers Squibb/Eli Lilly, Boehringer Ingelheim, HLS Therapeutics, and JAMP Pharma. J. G. received research funding from AstraZeneca for the work under consideration. M. G. C. has received speaker/consulting honoraria and/or research grant support from AstraZeneca, Medtronic, Abiomed, and Merit Medical. K. A. S. is an employee of AstraZeneca. T. S. has received speaker/consulting honoraria and/or research grant support from Astellas, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, GlaxoSmithKline, Merck, Novartis, Pfizer, and Sanofi. D. W. has received speaker/consulting honoraria and/or research grant support from AstraZeneca, Bayer, Berlin‐Chemie, Biotronik, and Novartis. S. Y. has received speaker/consulting honoraria and/or research grant support from Takeda, Daiichi Sankyo, AstraZeneca, Boehringer Ingelheim, and BMS. D. B. has received speaker/consulting honoraria and/or research grant support from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, BMS, Eli Lilly, Merck, and Sanofi. S. G. G. has received research grant support (e.g., steering committee or data and safety monitoring committee) and/or speaker/consulting honoraria (e.g., advisory boards) from: Amgen, Anthos Therapeutics, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CSL Behring, Daiichi‐Sankyo/American Regent, Eli Lilly, Esperion, Ferring Pharmaceuticals, HLS Therapeutics, JAMP Pharma, Merck, Novartis, Novo Nordisk A/C, Pendopharm/Pharmascience, Pfizer, Regeneron, Sanofi, Servier, Valeo Pharma; and salary support/honoraria from the Heart and Stroke Foundation of Ontario/University of Toronto (Polo) Chair, Canadian Heart Research Centre and MD Primer, Canadian VIGOUR Centre, Cleveland Clinic Coordinating Centre for Clinical Research, Duke Clinical Research Institute, New York University Clinical Coordinating Centre, PERFUSE Research Institute, TIMI Study Group (Brigham Health). J. C. N. has received speaker/consulting honoraria and/or research grant support from Amgen, AstraZeneca, Bayer, Esperion, CLS Behring, Dalcor, Daiichi Sankyo, Janssen, Novartis, NovoNordisk, Sanofi, Servier, and Vifor. C. B. G. has received consulting honoraria and/or research grant support from Armetheon, AstraZeneca, Bayer, Boehringer Ingelheim, BMS, Daiichi Sankyo, Eli Lilly, Gilead, GlaxoSmithKline, Hoffmann‐La Roche, Janssen, Medtronic, Pfizer, Salix Pharmaceuticals, Sanofi, Takeda, and The Medicines Company. S. P. has received research grant support from AstraZeneca. The remaining authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Overlap of age, multimorbidity, and functional impairment. Functional impairment: at least some problem in one of the three relevant EQ‐5D components. EQ‐5D, 5‐dimension EuroQol.
Figure 2
Figure 2
Rate of events by age, functional impairment, and MM. (A) CV composite outcome (CV death, MI, stroke, or unstable angina). (B) CV death. (C) Non‐CV death. CV, cardiovascular; MI, myocardial infarction; MM, multimorbidity.
Figure 3
Figure 3
Adjusted* rate ratios for age, multimorbidity, and functional impairment. (A) CV composite (CV death, MI, stroke, urgent revascularization). (B) CV death. (C) Non‐CV death. *Age, multimorbidity, and functional impairment were mutually adjusted for the other variables. CV, cardiovascular; MI, myocardial infarction; Mod., moderate; Sev., severe.
See this image and copyright information in PMC

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