About SILVER...

The Yale School of Medicine received funding for the SILVER-AMI study on August 17th, 2012 through the National Institutes of Health (NIH). This is a multi-center observational study of 3,000 older persons (age ≥75 years) admitted to the hospital with a heart attack. The study has a national network of approximately 75 hospitals across the United States that recruits and enrolls participants. 

The Objectives of the Study:

1. To identify risk factors for all-cause hospital readmission, mortality and decline in health status following hospitalization for AMI among older persons. 

2. To develop and validate risk stratification tools for hospital readmission, mortality and decline in health status following hospitalization for AMI among older persons. 

3. To assess facilitators and barriers to use of risk stratification tools by physicians caring for older AMI patients.

Inclusion/ Exclusion Criteria

  1. Age ≥75 years upon admission to the hospital 
  2. Elevation of cardiac markers within 24 hours of presentation to the hospital 
    a.  Troponin must rise above the upper limit of normal established by the hospital as a determinate of cardiac injury
  3. Any one of the following:
    1. Symptoms of ischemia– pain in chest, epigastrum, jaw, or arm, lasting 20 minutes or longer. May be accompanied by dyspnea, diaphoresis, nausea, or syncope.
    2. ECG with ischemic changes:
      1. ST elevation
      2. ST depression
      3. T wave inversion in the absence of Left Ventricular Hypertrophy (LVH)
      4. New left bundle branch block (LBBB)
      5. Pathological Q waves
    3. Imaging evidence of Infarction (e.g. new loss of viable myocardium on nuclear imaging, new wall motion abnormality on echo, delayed gadolinium enhancement on MRI)
    4. Intracoronary thrombus on angiography

1. Patient transferred from another hospital with a length of stay >48 hours at the referring hospital

2. Refused Informed Consent

3. Decisional impairment with no legally authorized representative 

4. AMI is secondary to chest trauma

5. AMI is secondary to inpatient procedure or surgery

6. History of heart transplant 

7. Non-English speaking/Non-Spanish speaking

8. Inability to complete interview (e.g. comatose or aphasia) 

9. Inability to contact for follow-up (e.g. no access to phone, not living in the country) 

10. Currently a prisoner 

11. Death prior to enrollment

12. Previously enrolled in SILVER-AMI

13. Troponin elevation is the result of apical ballooning syndrome (i.e. Takotsubo)

Study Procedures

Baseline Visit:

• Interview and Physical Assessment 

The participant is enrolled in the study during their hospitalization for an acute myocardial infarction. The baseline visit includes an interview and physical evaluation. Participants are asked questions about their symptoms, risk factors, quality of life, mood, cognition, activities of daily living, social support, vision, hearing, medications, and income/socioeconomic status. Physical assessments include measurements of grip strength and mobility.

• Medical Record Review 

The SILVER-AMI study collects medical record information to understand the participant’s clinical profile and the care that was received during their hospital stay.

Post Discharge:

• Discharge Survey 

Participants receive a brief discharge survey to assess hospital-to-home care transitions.

6-Month Visit:

• Telephone Interview 

The participant completes a telephone interview with Yale Follow-up Center approximately 6 months after the baseline visit. The interview will reassess quality of life, mood, and symptoms, as well as focus on health status, medication side effects, adherence, and utilization.

• Outcomes Review 

The readmission review captures hospital visits and deaths that occur during the six month follow up period.

What is an AMI

An acute myocardial infarction (AMI) is commonly known as a heart attack.