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

  • Deborah A. LevineEmail author
  • Kenneth M. Langa
  • Andrzej Galecki
  • Mohammed Kabeto
  • Lewis B. Morgenstern
  • Darin B. Zahuranec
  • Bruno Giordani
  • Lynda D. Lisabeth
  • Brahmajee K. Nallamothu
Original Research

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.

Key Words

aging Alzheimer’s cardiovascular disease health services research 

Notes

Funding

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.

Supplementary material

11606_2019_5155_MOESM1_ESM.pdf (279 kb)
ESM 1 (PDF 279 kb)

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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Deborah A. Levine
    • 1
    • 2
    • 3
    Email author
  • Kenneth M. Langa
    • 1
    • 3
    • 4
    • 5
  • Andrzej Galecki
    • 1
    • 6
  • Mohammed Kabeto
    • 1
  • Lewis B. Morgenstern
    • 2
  • Darin B. Zahuranec
    • 2
  • Bruno Giordani
    • 7
  • Lynda D. Lisabeth
    • 2
    • 8
  • Brahmajee K. Nallamothu
    • 1
    • 3
    • 4
  1. 1.Department of Internal MedicineUniversity of Michigan (U-M)Ann ArborUSA
  2. 2.Department of Neurology and Stroke ProgramU-MAnn ArborUSA
  3. 3.Institute for Healthcare Policy and InnovationU-MAnn ArborUSA
  4. 4.VA Ann Arbor Healthcare SystemAnn ArborUSA
  5. 5.Institute for Social ResearchU-MAnn ArborUSA
  6. 6.Department of BiostatisticsU-MAnn ArborUSA
  7. 7.Department of Psychiatry & Michigan Alzheimer’s Disease CenterU-MAnn ArborUSA
  8. 8.Department of EpidemiologyU-MAnn ArborUSA

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