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Comprehensive Evaluation of Risk Factors in Older Patients with AMI (SILVER-AMI)

What is the SILVER-AMI study?

SILVER-AMI is the first, large observational, mixed-methods study of the older (≥75 years) population experiencing a heart attack.

What is a risk stratification tool used for?

Risk stratification models are helpful for medical decision making in the recovery period of a heart attack. People judged to be at higher risk may receive closer observation and/or earlier treatment, while people at lower risk may be reassured and managed less aggressively. Underscoring the importance of risk models in older patients is the finding that physicians inaccurately estimate their risk for adverse clinical outcomes when using implicit assessments. Accordingly, ACC/AHA practice guidelines endorse the routine use of risk models.

Why are we doing this research?

Among patients presenting with myocardial infarction (MI), 30% are 75 years or older. The prevalence of MI in this age group is expected to substantially increase in the next 30 years with the aging of the baby-boomer generation. Yet, this group has been under-represented in clinical studies. Among MI studies that have included the elderly, fewer than 10% of patients are 75 years or older. Their high burden of comorbid conditions and lower reserve make this age group more complex than younger patients. Currently available risk models were developed using data from younger patients, and they do not perform well in older patients. This study will address these gaps by combining principles from geriatrics and cardiology to create post-MI risk models specifically designed for older patients.

Objective of Study

The overall objective of this study is to develop and validate risk stratification tools for older adults who have recently had a myocardial infarction, also known as a heart attack. The tools we develop are intended for use in clinical care (i.e. take 15 minutes or less). This is foundational work: a necessary prerequisite for developing recovery strategies for older patients following a myocardial infarction.


SILVER-AMI has completed its enrollment on October 31, 2016.