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

Abstract

BACKGROUND: 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. OBJECTIVE: To compare receipt of treatments for acute myocardial infarction (AMI) between older adults with pre-existing MCI and cognitively normal patients. DESIGN: Prospective study using data from the nationally representative Health and Retirement Study, Medicare, and American Hospital Association. PARTICIPANTS: 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). MAIN MEASURES: Receipt of cardiac catheterization and coronary revascularization within 30 days and cardiac rehabilitation within 1 year of AMI hospitalization. KEY RESULTS: 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). CONCLUSIONS: Pre-existing MCI is associated with lower use of cardiac catheterization and coronary revascularization but not cardiac rehabilitation after AMI.

Physician decision-making and recommendations for stroke and myocardial infarction treatments in older adults with mild cognitive impairment

“…Previous studies have shown that pre-existing MCI was associated with lower likelihood of receiving invasive treatments (e.g., cardiac catheterization and coronary revascularization) after AMI. [11,12] The association between patient MCI and receipt of non-invasive treatments such as cardiac rehabilitation is unclear but one study has found lower likelihood of physician referral and patient participation in cardiac rehabilitation. [11] Differences in use of secondary preventive medications after AIS and AMI are also unclear with one study finding similar use of AMI medications by cognitive status.…”

“…[7][8][9][10] Yet evidence suggests older adults with MCI get fewer established, effective treatments after AMI than those with normal cognition. [11,12] It is unknown how a patient's MCI influences physician decision-making and recommendations for AIS and AMI treatments.…”

Disparities in the Use of Guideline-Based Pharmacotherapy Exist for Atherosclerotic Cardiovascular Disease and Heart Failure Patients Who Have Intellectual/Developmental Disabilities in a Commercially Insured Database

“…[38][39][40][41] Female gender, minority status, and to some extent, younger age are associated with lower likelihood of receiving medication therapy for conditions such as cardiovascular disease, diabetes, asthma, HF, and HIV infections. A recent study by Levine et al 42 found that older adults who have mild cognitive impairment and who experienced a myocardial infarction were less likely to receive cardiac catheterization, coronary revascularization, and cardiac rehabilitation. Likewise, people with severe mental illness also receive lower rates of invasive coronary interventions after a cardiac event.…”

Presentation, Treatment, and Outcomes of Older Adults Hospitalized for Acute Myocardial Infarction According to Cognitive Status: The SILVER-AMI Study

“…The few studies that have examined CI as a predictor of outcomes have reported mixed results. 7,12,13 Importantly, prior studies often used measures of cognition collected prior to or after, not during, acute myocardial infarction hospitalization, 7,12,14 and thus did not characterize cognitive status during admission, during which treatment decisions are made and important information about disease management is communicated to patients. The objective of this study was, therefore, to examine the association of cognition, measured during hospitalization, with risk of mortality and readmissions at 6 months post-discharge in a large prospective sample of acute myocardial infarction patients ages 75 years and older.…”