The effect of dementia on outcomes and process of care for Medicare beneficiaries admitted with acute myocardial infarction.
OBJECTIVE
To determine differences in mortality after admission for acute myocardial infarction (AMI) and in use of noninvasive and invasive treatments for AMI between patients with and without dementia.


METHODS
Retrospective chart review.


METHODS
Cooperative Cardiovascular Project.


METHODS
Medicare patients admitted for AMI (N=129,092) in 1994 and 1995.


METHODS
Dementia noted on medical chart as history of dementia, Alzheimer's disease, chronic confusion, or senility. Outcome measures included mortality at 30 days and 1-year postadmission; use of aspirin, beta-blocker, angiotensin-converting enzyme (ACE) inhibitor, thrombolytic therapy, cardiac catheterization, coronary angioplasty, and cardiac bypass surgery compared by dementia status.


RESULTS
Dementia was associated with higher mortality at 30 days (relative risk (RR)=1.16, 95% confidence interval (CI)=1.09-1.22) and at 1-year postadmission (RR=1.18, 95% CI=1.13-1.23). There were few to no differences in the use of aspirin and beta-blockers between patients with and without a history of dementia. Patients with a history of dementia were less likely to receive ACE inhibitors during the stay (RR=0.89, 95% CI=0.86-0.93) or at discharge (RR=0.90, 95% CI=0.86-0.95), thrombolytic therapy (RR=0.82, 95% CI=0.74-0.90), catheterization (RR=0.51, 95% CI=0.47-0.55), coronary angioplasty (RR=0.58, 95% CI=0.51-0.66), and cardiac bypass surgery (RR=0.41, 95% CI=0.33-0.50) than patients without a history of dementia.


CONCLUSIONS
The results imply that the presence of dementia had a major effect on mortality and care patterns for this condition.
Sloan
Frank A
FA
Department of Economics and Clinical Research Institute, Duke University, Durham, North Carolina 27708, USA. fsloan@hpolicy.duke.edu
Trogdon
Justin G
JG
Curtis
Lesley H
LH
Schulman
Kevin A
KA
D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003657:Decision Making; D003704:Dementia / Q000150:complications*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008485:Medical Audit; D006278:Medicare / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
D002317:Cardiovascular Agents