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Mild Cognitive Impairment and Receipt of Treatments for Acute Myocardial Infarction in Older Adults.

Authors
  • Levine, Deborah A1, 2, 3
  • Langa, Kenneth M4, 5, 6, 7
  • Galecki, Andrzej4, 8
  • Kabeto, Mohammed4
  • Morgenstern, Lewis B9
  • Zahuranec, Darin B9
  • Giordani, Bruno10
  • Lisabeth, Lynda D9, 11
  • Nallamothu, Brahmajee K4, 5, 6
  • 1 Department of Internal Medicine, University of Michigan (U-M), North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor, MI, 48109-2800, USA. [email protected]
  • 2 Department of Neurology and Stroke Program, U-M, Ann Arbor, MI, USA. [email protected]
  • 3 Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI, USA. [email protected]
  • 4 Department of Internal Medicine, University of Michigan (U-M), North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor, MI, 48109-2800, USA.
  • 5 Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI, USA.
  • 6 VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
  • 7 Institute for Social Research, U-M, Ann Arbor, MI, USA.
  • 8 Department of Biostatistics, U-M, Ann Arbor, MI, USA.
  • 9 Department of Neurology and Stroke Program, U-M, Ann Arbor, MI, USA.
  • 10 Department of Psychiatry & Michigan Alzheimer's Disease Center, U-M, Ann Arbor, MI, USA.
  • 11 Department of Epidemiology, U-M, Ann Arbor, MI, USA.
Type
Published Article
Journal
Journal of General Internal Medicine
Publisher
Springer-Verlag
Publication Date
Jan 01, 2020
Volume
35
Issue
1
Pages
28–35
Identifiers
DOI: 10.1007/s11606-019-05155-8
PMID: 31410812
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Older adults with mild cognitive impairment (MCI) should receive evidence-based treatments when indicated. Providers and patients may overestimate the risk of dementia in patients with MCI leading to potential under-treatment. However, the association between pre-existing MCI and receipt of evidence-based treatments is uncertain. To compare receipt of treatments for acute myocardial infarction (AMI) between older adults with pre-existing MCI and cognitively normal patients. Prospective study using data from the nationally representative Health and Retirement Study, Medicare, and American Hospital Association. Six hundred nine adults aged 65 or older hospitalized for AMI between 2000 and 2011 and followed through 2012 with pre-existing MCI (defined as modified Telephone Interview for Cognitive Status score of 7-11) and normal cognition (score of 12-27). Receipt of cardiac catheterization and coronary revascularization within 30 days and cardiac rehabilitation within 1 year of AMI hospitalization. Among the survivors of AMI, 19.2% had pre-existing MCI (55.6% were women and 44.4% were male, with a mean [SD] age of 82.3 [7.5] years), and 80.8% had normal cognition (45.7% were women and 54.3% were male, with a mean age of 77.1 [7.1] years). Survivors of AMI with pre-existing MCI were significantly less likely than those with normal cognition to receive cardiac catheterization (50% vs 77%; P < 0.001), coronary revascularization (29% vs 63%; P < 0.001), and cardiac rehabilitation (9% vs 22%; P = 0.001) after AMI. After adjusting for patient and hospital factors, pre-existing MCI remained associated with lower use of cardiac catheterization (adjusted hazard ratio (aHR), 0.65; 95% CI, 0.48-0.89; P = 0.007) and coronary revascularization (aHR, 0.55; 95% CI, 0.37-0.81; P = .003), but not cardiac rehabilitation (aHR, 1.01; 95% CI, 0.49-2.07; P = 0.98). Pre-existing MCI is associated with lower use of cardiac catheterization and coronary revascularization but not cardiac rehabilitation after AMI.

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