title: Physical function and independence 1 year after myocardial infarction: observations from the Translational Research Investigating Underlying disparities in recovery from acute Myocardial infarction: Patients' Health status registry.
abstract: BACKGROUND
  Acute myocardial infarction (AMI) may contribute to health status declines including "independence loss" and "physical function decline." Despite the importance of these outcomes for prognosis and quality of life, their incidence and predictors have not been well described.
  
  
  METHODS
  We studied 2,002 patients with AMI enrolled across 24 sites in the TRIUMPH registry who completed assessments of independence and physical function at the time of AMI and 1 year later. Independence was evaluated by the EuroQol-5D (mobility, self-care, and usual activities), and physical function was assessed with the Short Form-12 physical component score. Declines in ≥1 level on EuroQol-5D and >5 points in PCS were considered clinically significant changes. Hierarchical, multivariable, modified Poisson regression models accounting for within-site variability were used to identify predictors of independence loss and physical function decline.
  
  
  RESULTS
  One-year post AMI, 43.0% of patients experienced health status declines: 12.8% independence loss alone, 15.2% physical function decline alone, and 15.0% both. After adjustment, variables that predicted independence loss included female sex, nonwhite race, unmarried status, uninsured status, end-stage renal disease, and depression. Variables that predicted physical function decline were uninsured status, lack of cardiac rehabilitation referral, and absence of pre-AMI angina. Age was not predictive of either outcome after adjustment.
  
  
  CONCLUSIONS
  >40% of patients experience independence loss or physical function decline 1 year after AMI. These changes are distinct but can occur simultaneously. Although some risk factors are not modifiable, others suggest potential targets for strategies to preserve patients' health status.
authors.affiliation: Department of Internal Medicine, Section of Cardiology, Yale University School of Medicine, New Haven, CT 06520, USA. john.dodson@yale.edu
authors.forename: John A
authors.initials: JA
authors.lastname: Dodson
authors.forename: Suzanne V
authors.initials: SV
authors.lastname: Arnold
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Reid
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Gill
authors.forename: Michael W
authors.initials: MW
authors.lastname: Rich
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.forename: Karen P
authors.initials: KP
authors.lastname: Alexander
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D001294:Attitude to Health; D006328:Cardiac Catheterization / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D003863:Depression / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D057187:Independent Living / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D010809:Physical Fitness / Q000502:physiology*; D016012:Poisson Distribution; D011237:Predictive Value of Tests; D011788:Quality of Life; D012042:Registries; D018570:Risk Assessment; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D017741:Survivors; D013997:Time Factors; D057170:Translational Research, Biomedical