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

Hajduk, Alexandra M.; Saczynski, Jane S.; Tsang, Sui; Geda, Mary; Dodson, John A.; Ouellet, Gregory M.; Goldberg, Robert J.; Chaudhry, Sarwat I.

doi:10.1016/j.amjmed.2021.03.003

Cited by 11 publications

(9 citation statements)

References 36 publications

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“…The Cooperative Cardiovascular Project of 129,092 patients with AMI found that dementia was associated with higher mortality up to one year post-admission [ 163 ]. Similarly, the SILVER-AMI study of 3041 patients > 75 years old with AMI found that mild, moderate and severe CI were all associated with increased risk of readmission, with moderate-severe CI associated with increased risk of death [ 163 ].…”

Section: Resultsmentioning

confidence: 99%

Acute Myocardial Infarction and Risk of Cognitive Impairment and Dementia: A Review

Thong,

Quek,

Loo

et al. 2023

Biology

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Cognitive impairment (CI) shares common cardiovascular risk factors with acute myocardial infarction (AMI), and is increasingly prevalent in our ageing population. Whilst AMI is associated with increased rates of CI, CI remains underreported and infrequently identified in patients with AMI. In this review, we discuss the evidence surrounding AMI and its links to dementia and CI, including pathophysiology, risk factors, management and interventions. Vascular dysregulation plays a major role in CI, with atherosclerosis, platelet activation, microinfarcts and perivascular inflammation resulting in neurovascular unit dysfunction, disordered homeostasis and a dysfunctional neurohormonal response. This subsequently affects perfusion pressure, resulting in enlarged periventricular spaces and hippocampal sclerosis. The increased platelet activation seen in coronary artery disease (CAD) can also result in inflammation and amyloid-β protein deposition which is associated with Alzheimer’s Dementia. Post-AMI, reduced blood pressure and reduced left ventricular ejection fraction can cause chronic cerebral hypoperfusion, cerebral infarction and failure of normal circulatory autoregulatory mechanisms. Patients who undergo coronary revascularization (percutaneous coronary intervention or bypass surgery) are at increased risk for post-procedure cognitive impairment, though whether this is related to the intervention itself or underlying cardiovascular risk factors is debated. Mortality rates are higher in dementia patients with AMI, and post-AMI CI is more prevalent in the elderly and in patients with post-AMI heart failure. Medical management (antiplatelet, statin, renin-angiotensin system inhibitors, cardiac rehabilitation) can reduce the risk of post-AMI CI; however, beta-blockers may be associated with functional decline in patients with existing CI. The early identification of those with dementia or CI who present with AMI is important, as subsequent tailoring of management strategies can potentially improve outcomes as well as guide prognosis.

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Section: Resultsmentioning

confidence: 99%

Acute Myocardial Infarction and Risk of Cognitive Impairment and Dementia: A Review

Thong,

Quek,

Loo

et al. 2023

Biology

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“…51 In another analysis from the SILVER-AMI cohort, cognitive impairment was present in 17% of participants. 52 Women had a higher prevalence of cognitive impairment compared with men (NSTEMI: 20.6% versus 14.3%; P <0.001), posing challenges for timely presentation to the emergency department and the description and recall of symptoms. 51 Heart failure, symptoms other than chest pain, and being Black or Hispanic American were also associated with delayed arrival at the hospital.…”

Section: Diagnostic and Disease-based Classification Of Acs In Older ...mentioning

confidence: 95%

Management of Acute Coronary Syndrome in the Older Adult Population: A Scientific Statement From the American Heart Association

Damluji¹,

Forman²,

Wang³

et al. 2023

Circulation

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Diagnostic and therapeutic advances during the past decades have substantially improved health outcomes for patients with acute coronary syndrome. Both age-related physiological changes and accumulated cardiovascular risk factors increase the susceptibility to acute coronary syndrome over a lifetime. Compared with younger patients, outcomes for acute coronary syndrome in the large and growing demographic of older adults are relatively worse. Increased atherosclerotic plaque burden and complexity of anatomic disease, compounded by age-related cardiovascular and noncardiovascular comorbid conditions, contribute to the worse prognosis observed in older individuals. Geriatric syndromes, including frailty, multimorbidity, impaired cognitive and physical function, polypharmacy, and other complexities of care, can undermine the therapeutic efficacy of guidelines-based treatments and the resiliency of older adults to survive and recover, as well. In this American Heart Association scientific statement, we (1) review age-related physiological changes that predispose to acute coronary syndrome and management complexity; (2) describe the influence of commonly encountered geriatric syndromes on cardiovascular disease outcomes; and (3) recommend age-appropriate and guideline-concordant revascularization and acute coronary syndrome management strategies, including transitions of care, the use of cardiac rehabilitation, palliative care services, and holistic approaches. The primacy of individualized risk assessment and patient-centered care decision-making is highlighted throughout.

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“…34 Cardiac patients with cognitive impairment more frequently have major adverse cardiovascular (recurrent) events than the rest of the population, which is in turn associated with further cognitive decline. 12,35…”

Section: Coronary Artery Diseasementioning

confidence: 99%

Cognitive Impairment in Patients With Cardiac Disease: Implications for Clinical Practice

Nieuwkerk

Delewi

Wolters

et al. 2023

Stroke

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Cognitive impairment is common in patients with cardiovascular disease. One in 3 patients presenting at cardiology clinics have some degree of cognitive impairment, depending on the cardiac condition, comorbidities, and age. In up to half of these cases cognitive impairment may go unrecognized; however, it may affect self-management and treatment adherence. The high prevalence of cognitive impairment in patients with cardiac disease is likely due to shared risk factors, as well as direct consequences of cardiac dysfunction on the brain. Moreover, cardiac interventions may have beneficial as well as adverse effects on cognitive functioning. In this review, we describe prevalence and risk factors for cognitive impairment in patients with several common cardiac conditions: heart failure, coronary artery disease, and aortic valve stenosis. We discuss the potential effects of guideline-based treatments on cognition and identify open questions and unmet needs. Given the high prevalence of unrecognized cognitive impairment in cardiac patients, we recommend a stepwise approach to improve detection and management of cognitive impairment.

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

Cited by 11 publications

References 36 publications

Acute Myocardial Infarction and Risk of Cognitive Impairment and Dementia: A Review

Acute Myocardial Infarction and Risk of Cognitive Impairment and Dementia: A Review

Management of Acute Coronary Syndrome in the Older Adult Population: A Scientific Statement From the American Heart Association

Cognitive Impairment in Patients With Cardiac Disease: Implications for Clinical Practice

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