title: Design and rationale of the comprehensive evaluation of risk factors in older patients with AMI (SILVER-AMI) study.
abstract: BACKGROUND
  While older adults (age 75 and over) represent a large and growing proportion of patients with acute myocardial infarction (AMI), they have traditionally been under-represented in cardiovascular studies. Although chronological age confers an increased risk for adverse outcomes, our current understanding of the heterogeneity of this risk is limited. The Comprehensive Evaluation of Risk Factors in Older Patients with AMI (SILVER-AMI) study was designed to address this gap in knowledge by evaluating risk factors (including geriatric impairments, such as muscle weakness and cognitive impairments) for hospital readmission, mortality, and health status decline among older adults hospitalized for AMI.
  
  
  METHODS
  SILVER-AMI is a prospective cohort study that is enrolling 3000 older adults hospitalized for AMI from a recruitment network of approximately 70 community and academic hospitals across the United States. Participants undergo a comprehensive in-hospital assessment that includes clinical characteristics, geriatric impairments, and health status measures. Detailed medical record abstraction complements the assessment with diagnostic study results, in-hospital procedures, and medications. Participants are subsequently followed for six months to determine hospital readmission, mortality, and health status decline. Multivariable regression will be used to develop risk models for these three outcomes.
  
  
  CONCLUSIONS
  SILVER-AMI will fill critical gaps in our understanding of AMI in older patients. By incorporating geriatric impairments into our understanding of post-AMI outcomes, we aim to create a more personalized assessment of risk and identify potential targets for interventions.
  
  
  BACKGROUND
  
  
  
  BACKGROUND
  NCT01755052 .
authors.affiliation: Leon H Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, USA. John.Dodson@nyumc.org.
authors.forename: John A
authors.initials: JA
authors.lastname: Dodson
authors.affiliation: Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. mary.geda@yale.edu.
authors.forename: Mary
authors.initials: M
authors.lastname: Geda
authors.affiliation: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. harlan.krumholz@yale.edu.|Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA. harlan.krumholz@yale.edu.|Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, CT, USA. harlan.krumholz@yale.edu.|Department of Health Policy and Administration, Yale School of Public Health, New Haven, CT, USA. harlan.krumholz@yale.edu.
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.affiliation: Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. nancy.lorenze@yale.edu.
authors.forename: Nancy
authors.initials: N
authors.lastname: Lorenze
authors.affiliation: Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. Terrence.murphy@yale.edu.
authors.forename: Terrence E
authors.initials: TE
authors.lastname: Murphy
authors.affiliation: Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. heather.allore@yale.edu.
authors.forename: Heather G
authors.initials: HG
authors.lastname: Allore
authors.affiliation: Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. peter.charpentier@yale.edu.
authors.forename: Peter
authors.initials: P
authors.lastname: Charpentier
authors.affiliation: Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. sui.tsang@yale.edu.
authors.forename: Sui W
authors.initials: SW
authors.lastname: Tsang
authors.affiliation: Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. denise.acampora@yale.edu.
authors.forename: Denise
authors.initials: D
authors.lastname: Acampora
authors.affiliation: Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. mary.tinetti@yale.edu.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Tinetti
authors.affiliation: Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. thomas.gill@yale.edu.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Gill
authors.affiliation: Section of General Internal Medicine, Yale University School of Medicine, Harkness Office Building, Room 411, New Haven, CT, 06520, USA. Sarwat.Chaudhry@yale.edu.
authors.forename: Sarwat I
authors.initials: SI
authors.lastname: Chaudhry
mesh_terms: D000208:Acute Disease / Q000453:epidemiology*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D009026:Mortality; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000401:mortality*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology