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

An Analysis from a Nationwide Cohort under the National Health Insurance Coverage

  • Original Research Article
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Abstract

Background

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).

Objective

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

Methods

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.

Results

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 %).

Conclusion

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

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Acknowledgments

This work was supported by grants (DOH099-FDA-41005 and DOH101-TD-B-111-001) from the Bureau of Food and Drug Administration, Department of Health, Taiwan. The authors have no conflicts of interest that are directly relevant to the content of this study.

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Correspondence to Fei-Yuan Hsiao or Li-Jiuan Shen.

Additional information

F.-Y. Hsiao, L.-J. Shen contributed equally to the study.

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Lin, CF., Wu, FL.L., Lin, SW. et al. Age, Dementia and Care Patterns after Admission for Acute Coronary Syndrome. Drugs Aging 29, 819–828 (2012). https://doi.org/10.1007/s40266-012-0011-6

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  • DOI: https://doi.org/10.1007/s40266-012-0011-6

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