Dawning of a new era: understanding the functional outcomes of cardiovascular disease.

P atients, their families, and physicians are increasingly concerned with cognitive, functional, and psychological outcomes of chronic and acute medical conditions. This has lead to increased emphasis on patient-reported outcomes (PROs), such as quality of life (QoL), depression, anxiety and functional and cognitive status, in observational studies. In addition, the consolidated standards of reporting trial statement was recently updated to include standards for reporting PROs in randomized controlled trials, highlighting the awareness of including PROs as key outcomes of trials. 1 The development of the Patient-Centered Outcomes Research Institute in 2010, with an emphasis on answering questions most important to patients, their caregivers, and providers, further increased the attention paid to PROs by clinical outcomes researchers. 2 During the same time period, a posthospital syndrome has been described as a period of generalized risk after hospitalization when patients may experience impairments in physical, psychological, and cog-nitive function and are vulnerable to poor health outcomes, seemingly unrelated to the condition for which they were hospitalized. 3 The recognition and characterization of the posthospital syndrome have further enhanced interest in characterizing the patient beyond the clinical factors contained in the medical record. In this issue of Circulation: Cardiovascular Quality and Outcomes, Levine et al 4 present data on trajectories of cog-nitive and physical function after hospitalization for acute myocardial infarction (MI) or stroke. Data from the Health and Retirement Study are unique in that they include detailed cognitive and physical function assessments before (≤10 years) and after (≤13 years) hospitalizations. Linking claims data with detailed study assessments of cognitive and physical function allowed the authors to control for prehospitaliza-tion rate of decline, so that they could answer the question, " Am I going to develop impairments at a faster rate than I did before I had this stroke/heart attack? " Hospitalization for MI and stroke each increased the rate of developing additional functional impairments and the rate of development of impairments after hospitalization increased most rapidly in those with the fewest impairments before hospitalization. Hospitalization for stroke, but not MI, increased the odds of subsequent moderate to severe cognitive impairment. The authors suggest that their findings have important implications for increased surveillance for functional impairments after stroke and MI hospitalizations. These results of this study also have implications for routine screening of cognitive and physical function in all, and particularly older, patients. Because the rate of development of functional impairments changed most …