Drugs & Aging

, Volume 29, Issue 10, pp 819–828

Age, Dementia and Care Patterns after Admission for Acute Coronary Syndrome

An Analysis from a Nationwide Cohort under the National Health Insurance Coverage
  • Chen-Fang Lin
  • Fe-Lin Lin Wu
  • Shu-Wen Lin
  • Chyi-Huey Bai
  • Ding-Cheng Chan
  • Churn-Shiouh Gau
  • Fei-Yuan Hsiao
  • Li-Jiuan Shen
Original Research Article



The number of elderly and the prevalence of dementia have grown considerably in recent years. Little is known about how aging and dementia affect care patterns after discharge for acute coronary syndrome (ACS).


This study was designed to assess the impact of dementia on care patterns after admission for patients with ACS across different age groups.


Of 87,321 patients hospitalized for ACS between 1 January 2006 and 31 December 2007, 1,835 patients with dementia and 3,670 matched patients without dementia (1:2 ratio, matched by age, sex and hospital level) were identified from Taiwan’s National Health Insurance Research Database. Use of interventional therapies at hospitalization and guideline-recommended medications post-discharge were compared between patients with and without dementia across different age groups (≤65, 66–75, 76–85, ≥86 years). Multivariate logistic regression models were performed to examine the impact of dementia on care patterns.


Overall, dementia was associated with a 27 % lower likelihood of receipt of interventional therapies [adjusted odds ratio (OR) = 0.73; 95 % CI 0.63, 0.83] and a 22 % lower likelihood of guideline-recommended medications (adjusted OR = 0.78; 95 % CI 0.68, 0.89) in ACS patients. The use of interventional therapies and guideline-recommended medications decreased with age, and interactions between age and dementia were found. The proportions of patients receiving interventional therapies were 39.4 % (without dementia) versus 21.8 % (with dementia) in the youngest age group and 18.6 % (without dementia) versus 14.5 % (with dementia) in the oldest age group. Patients with dementia (age ≤65 years 73.6 %; age 66–75 years 82.3 %; age 76–85 years 71.8 %; age ≥86 years 55.6 %) were less likely to receive guideline-recommended medications as compared with those without dementia (age ≤65 years 85.6 %; age 66–75 years 87.5 %; age 76–85 years 81.2 %; age ≥86 years 62.0 %).


Dementia and aging were associated with decreased use of interventional therapies and guideline-recommended medications in ACS patients.


  1. 1.
    Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001;345(7):494–502.PubMedCrossRefGoogle Scholar
  2. 2.
    Freemantle N, Cleland J, Young P, Mason J, Harrison J. Beta blockade after myocardial infarction: systematic review and meta regression analysis. BMJ. 1999;318(7200):1730–7.PubMedCrossRefGoogle Scholar
  3. 3.
    ACE Inhibitor Myocardial Infarction Collaborative Group. Indications for ACE inhibitors in the early treatment of acute myocardial infarction: systematic overview of individual data from 100,000 patients in randomized trials. Circulation. 1998;97(22):2202–12.Google Scholar
  4. 4.
    Dagenais GR, Pogue J, Fox K, Simoons ML, Yusuf S. Angiotensin-converting-enzyme inhibitors in stable vascular disease without left ventricular systolic dysfunction or heart failure: a combined analysis of three trials. Lancet. 2006;368(9535):581–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet. 2005;366(9493):1267–78.PubMedCrossRefGoogle Scholar
  6. 6.
    Soiza RL, Leslie SJ, Harrild K, Peden NR, Hargreaves AD. Age-dependent differences in presentation, risk factor profile, and outcome of suspected acute coronary syndrome. J Am Geriatr Soc. 2005;53(11):1961–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Avezum A, Makdisse M, Spencer F, Gore JM, Fox KA, Montalescot G, et al. Impact of age on management and outcome of acute coronary syndrome: observations from the Global Registry of Acute Coronary Events (GRACE). Am Heart J. 2005;149(1):67–73.PubMedCrossRefGoogle Scholar
  8. 8.
    Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005;294(6):716–24.PubMedCrossRefGoogle Scholar
  9. 9.
    Margulis AV, Choudhry NK, Dormuth CR, Schneeweiss S. Variation in initiating secondary prevention after myocardial infarction by hospitals and physicians, 1997 through 2004. Pharmacoepidemiol Drug Saf. 2011;20(10):1088–97.PubMedCrossRefGoogle Scholar
  10. 10.
    Yusuf S, Islam S, Chow CK, Rangarajan S, Dagenais G, Diaz R, et al. Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries (the PURE study): a prospective epidemiological survey. Lancet. 2011;378(9798):1231–43.PubMedCrossRefGoogle Scholar
  11. 11.
    Schoenenberger AW, Radovanovic D, Stauffer JC, Windecker S, Urban P, Eberli FR, et al. Age-related differences in the use of guideline-recommended medical and interventional therapies for acute coronary syndromes: a cohort study. J Am Geriatr Soc. 2008;56(3):510–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Yan RT, Yan AT, Tan M, Chow CM, Fitchett DH, Ervin FL, et al. Age-related differences in the management and outcome of patients with acute coronary syndromes. Am Heart J. 2006;151(2):352–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Rosengren A, Wallentin L, Simoons M, Gitt AK, Behar S, Battler A, et al. Age, clinical presentation, and outcome of acute coronary syndromes in the Euroheart acute coronary syndrome survey. Eur Heart J. 2006;27(7):789–95.PubMedCrossRefGoogle Scholar
  14. 14.
    Barchielli A, Buiatti E, Balzi D, Santoro GM, Carrabba N, Fabiani P, et al. Age-related changes in treatment strategies for acute myocardial infarction: a population-based study. J Am Geriatr Soc. 2004;52(8):1355–60.PubMedCrossRefGoogle Scholar
  15. 15.
    Rathore SS, Mehta RH, Wang Y, Radford MJ, Krumholz HM. Effects of age on the quality of care provided to older patients with acute myocardial infarction. Am J Med. 2003;114(4):307–15.PubMedCrossRefGoogle Scholar
  16. 16.
    Mehta RH, Rathore SS, Radford MJ, Wang Y, Krumholz HM. Acute myocardial infarction in the elderly: differences by age. J Am Coll Cardiol. 2001;38(3):736–41.PubMedCrossRefGoogle Scholar
  17. 17.
    Brogan GX Jr, Peterson ED, Mulgund J, Bhatt DL, Ohman EM, Gibler WB, et al. Treatment disparities in the care of patients with and without diabetes presenting with non-ST-segment elevation acute coronary syndromes. Diabetes Care. 2006;29(1):9–14.PubMedCrossRefGoogle Scholar
  18. 18.
    Bugiardini R, Yan AT, Yan RT, Fitchett D, Langer A, Manfrini O, et al. Factors influencing underutilization of evidence-based therapies in women. Eur Heart J. 2011;32(11):1337–44.PubMedCrossRefGoogle Scholar
  19. 19.
    Hasdai D, Haim M, Behar S, Boyko V, Battler A. Acute coronary syndromes in patients with prior cerebrovascular events: lessons from the Euro-Heart Survey of Acute Coronary Syndromes. Am Heart J. 2003;146(5):832–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Berger AK, Duval S, Krumholz HM. Aspirin, beta-blocker, and angiotensin-converting enzyme inhibitor therapy in patients with end-stage renal disease and an acute myocardial infarction. J Am Coll Cardiol. 2003;42(2):201–8.PubMedCrossRefGoogle Scholar
  21. 21.
    World Alzheimer Report: the global economic impact of dementia. London: Alzheimer’s Disease International (ADI). 2010.Google Scholar
  22. 22.
    Ferri CP, Prince M, Brayne C, Brodaty H, Fratiglioni L, Ganguli M, et al. Global prevalence of dementia: a Delphi consensus study. Lancet. 2005;366(9503):2112–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Kimata T, Hirakawa Y, Uemura K, Kuzuya M. Absence of outcome difference in elderly patients with and without dementia after acute myocardial infarction. Int Heart J. 2008;49(5):533–43.PubMedCrossRefGoogle Scholar
  24. 24.
    Hirakawa Y, Masuda Y, Kuzuya M, Iguchi A, Uemura K. Differences in cardiac management and in-hospital mortality between elderly patients with and without dementia after acute myocardial infarction: findings from TAMIS data. Nippon Ronen Igakkai Zasshi. 2007;44(5):606–10.PubMedCrossRefGoogle Scholar
  25. 25.
    Cordero A, Morillas P, Bertomeu-González V, Quiles J, Soria F, Guindo J, et al. Pathological ankle-brachial index is equivalent of advanced age in acute coronary syndromes. Eur J Clin Invest. 2011;41(12):1268–74.PubMedCrossRefGoogle Scholar
  26. 26.
    Sloan FA, Trogdon JG, Curtis LH, Schulman KA. The effect of dementia on outcomes and process of care for Medicare beneficiaries admitted with acute myocardial infarction. J Am Geriatr Soc. 2004;52(2):173–81.PubMedCrossRefGoogle Scholar
  27. 27.
    International classification of diseases, ninth revision (ICD-9). Geneva: World Health Organization; 2011.Google Scholar
  28. 28.
    Wu CS, Ting TT, Wang SC, Chang IS, Lin KM. Effect of benzodiazepine discontinuation on dementia risk. Am J Geriatr Psychiatry. 2011;19(2):151–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Brown AF, Mangione CM, Saliba D, Sarkisian CA. Guidelines for improving the care of the older person with diabetes mellitus. J Am Geriatr Soc. 2003; (5 Suppl Guidelines):S265–80.Google Scholar
  30. 30.
    Parsons C, Hughes CM, Passmore AP, Lapane KL. Withholding, discontinuing and withdrawing medications in dementia patients at the end of life: a neglected problem in the disadvantaged dying? Drugs Aging. 2010;27(6):435–49.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2012

Authors and Affiliations

  • Chen-Fang Lin
    • 1
    • 2
  • Fe-Lin Lin Wu
    • 1
    • 3
    • 4
  • Shu-Wen Lin
    • 1
    • 3
    • 4
  • Chyi-Huey Bai
    • 5
    • 6
  • Ding-Cheng Chan
    • 7
    • 8
  • Churn-Shiouh Gau
    • 1
    • 3
  • Fei-Yuan Hsiao
    • 1
    • 3
  • Li-Jiuan Shen
    • 1
    • 3
    • 4
  1. 1.School of Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
  2. 2.Department of PharmacyShin Kong WHS Memorial HospitalTaipeiTaiwan
  3. 3.Graduate Institute of Clinical Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
  4. 4.Department of PharmacyNational Taiwan University HospitalTaipeiTaiwan
  5. 5.School of Public HealthTaipei Medical UniversityTaipeiTaiwan
  6. 6.Central Laboratory, Shin Kong WHS Memorial HospitalTaipeiTaiwan
  7. 7.Department of Geriatrics and GerontologyNational Taiwan University HospitalTaipeiTaiwan
  8. 8.Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan

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