Mild Cognitive Impairment and Receipt of Treatments for Acute Myocardial Infarction in Older Adults
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.
Key Wordsaging Alzheimer’s cardiovascular disease health services research
This work was supported by NIH/NIA grant R01 AG051827 (Levine DA, PI). The Health and Retirement Study is funded by the NIH/NIA (U01 AG009740) and performed at the Institute for Social Research, University of Michigan, Ann Arbor.
Dr. Levine was also supported by NINDS R01 NS102715 (PI) and was consultant/advisory board UCSF (event adjudicator for POINT trial). Dr. Langa received funding support from NIH/NIA grants P30 AG053760 and P30 AG024824. Dr. Galecki and M. Kabeto also received funding support from NIH/NIA grant P30 AG024824.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they do not have a conflict of interest.
- 2.Alzheimer’s Association. 2014 Alzheimer’s disease facts and figures. Alzheimers Dement 2014;10(2):e47–92.Google Scholar
- 13.Ready RE, Ott BR, Grace J. Patient versus informant perspectives of Quality of Life in Mild Cognitive Impairment and Alzheimer’s disease. Int J Geriatr Psychiatry 2004;19(3):256–265.Google Scholar
- 18.Krumholz HM, Anderson JL, Bachelder BL, et al. ACC/AHA 2008 performance measures for adults with ST-elevation and non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for ST-Elevation and Non-ST-Elevation Myocardial Infarction) Developed in Collaboration with the American Academy of Family Physicians and American College of Emergency Physicians Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation, Society for Cardiovascular Angiography and Interventions, and Society of Hospital Medicine. J Am Coll Cardiol. 2008;52(24):2046–2099.CrossRefPubMedGoogle Scholar
- 19.Masoudi FA, Bonow RO, Brindis RG, et al. ACC/AHA 2008 statement on performance measurement and reperfusion therapy: a report of the ACC/AHA Task Force on Performance Measures (Work Group to address the challenges of performance measurement and reperfusion therapy). Circulation 2008;118(24):2649–2661.CrossRefPubMedGoogle Scholar
- 21.Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. The Bypass Angioplasty Revascularization Investigation (BARI) Investigators. N Engl J Med. 1996;335(4):217–225.Google Scholar
- 22.Five-year clinical and functional outcome comparing bypass surgery and angioplasty in patients with multivessel coronary disease. A multicenter randomized trial. Writing Group for the Bypass Angioplasty Revascularization Investigation (BARI) Investigators. JAMA 1997;277(9):715–721.Google Scholar
- 23.Anderson L, Taylor RS. Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev 2014;12:CD011273.Google Scholar
- 24.Dalal HM, Doherty P, Taylor RS. Cardiac rehabilitation. BMJ 2015;351.Google Scholar
- 28.Medicare. Your Medicare coverage. Cardiac rehabiliation programs. https://www.medicare.gov/coverage/cardiac-rehab-programs.html. Accessed 14 March 2019.
- 29.Plassman BL, Newman TT, Welsh KA, Helms M, Breitner JCS. Properties of the telephone interview for cognitive status—application in epidemiologic and longitudinal-studies. Neuropsychiatry Neuropsychol Behav Neurol 1994;7(3):235–241.Google Scholar
- 30.Welsh KA, Breitner JCS, Magruderhabib KM. Detection of dementia in the elderly using telephone screening of cognitive status. Neuropsychiatry Neuropsychol Behav Neurol 1993;6(2):103–110.Google Scholar
- 36.Piette JD, Rosland AM, Silveira M, Kabeto M, Langa KM. The case for involving adult children outside of the household in the self-management support of older adults with chronic illnesses. Chronic Illn 2010;6(1):34–45.Google Scholar
- 39.Sobel M. In: S. L, ed. Sociological Methodology. San Francisco: Jossey-Boss; 1982:290–312.Google Scholar
- 41.Steinberg BA, French WJ, Peterson E, Frederick PD, Cannon CP, National Registry of Myocardial Infarction I. Is coding for myocardial infarction more accurate now that coding descriptions have been clarified to distinguish ST-elevation myocardial infarction from non-ST elevation myocardial infarction? Am J Cardiol 2008;102(5):513–517.CrossRefPubMedGoogle Scholar
- 44.Gharacholou SM, Reid KJ, Arnold SV, et al. Cognitive impairment and outcomes in older adult survivors of acute myocardial infarction: findings from the translational research investigating underlying disparities in acute myocardial infarction patients’ health status registry. Am Heart J 2011;162(5):860–869 e861.CrossRefPubMedPubMedCentralGoogle Scholar
- 45.Kahneman D. Thinking, Fast and Slow. New York: Farrar, Straus and Giroux; 2011.Google Scholar
- 51.The ABCs of the annual wellness visit. Medicare Learning Network educational tool. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/AWV_chart_ICN905706.pdf. Accessed 14 March 2019.
- 52.Federal Interagency Forum on Aging-Related Statistics. Older Americans 2016: key indicators of well-being. Federal Interagency Forum on Aging-Related Statistics. Washington, DC: U.S. Government Printing Office; 2016. Available at: https://agingstats.gov/docs/latestreport/older-americans-2016-key-indicators-of-wellbeing.pdf. Accessed 14 March 2019.