title: 30-Day Mortality after Cardiovascular Events in Persons with or without Alzheimer's Disease.
abstract: OBJECTIVE
  Persons with Alzheimer's disease (AD) have been suggested to receive suboptimal treatment. We studied the 30-day mortality after ischemic stroke, hemorrhagic stroke, or myocardial infarction in individuals with or without AD.
  
  
  METHODS
  An exposure matched cohort of all Finnish community-dwellers diagnosed with clinically verified AD in 2005-2012 (n = 73,005) and 1-4 matched comparison persons/AD-affected person (n = 215,449). Data on 30-day mortality after ischemic stroke (n = 16,419; deaths: n = 2,748), hemorrhagic stroke (n = 3,570; deaths: n = 1,224), and myocardial infarction (n = 15,304; deaths: n = 3,804) were obtained from the National Hospital Discharge register. The main analyses were restricted to first-ever events.
  
  
  RESULTS
  Persons with AD had slightly higher 30-day mortality after ischemic stroke (adjusted HR 1.36, 95% Confidence interval (CI) 1.24,1.49), hemorrhagic stroke (adjusted HR 1.11, 95% CI 0.98,1.25), or myocardial infarction (adjusted HR, 1.40, 9% CI 1.30,1.51). The associations were not affected by age, gender, or co-morbidities and remained similar when patients with previous ischemic strokes or infarctions were included. The absolute risk increase in 30-day mortality after ischemic or hemorrhagic stroke and myocardial infarction were 4.9% (95% CI 3.3,6.5), 3.3% (95% CI - 1.6,8.2), and 7.5% (95% CI 5.0,10.0), respectively.
  
  
  CONCLUSIONS
  Although the 30-day mortality was somewhat higher in the AD cohort, the absolute differences were small indicating that acute treatment was not notably inferior in AD patients. The slightly higher mortality was not explained by co-morbidities but may reflect the higher mortality of AD persons in general, or treatment practice of patients with severe cognitive impairment.
authors.affiliation: Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland.|School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
authors.forename: Jari
authors.initials: J
authors.lastname: Heiskanen
authors.affiliation: School of Pharmacy, University of Eastern Finland, Kuopio, Finland.|Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
authors.forename: Sirpa
authors.initials: S
authors.lastname: Hartikainen
authors.affiliation: Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland.|Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland.
authors.forename: Risto P
authors.initials: RP
authors.lastname: Roine
authors.affiliation: Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland.|School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
authors.forename: Anna-Maija
authors.initials: AM
authors.lastname: Tolppanen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology* / Q000401:mortality*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D005387:Finland / Q000453:epidemiology; D006474:Hemorrhagic Disorders; D006801:Humans; D008297:Male; D009017:Morbidity; D009203:Myocardial Infarction; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D012111:Residence Characteristics; D020521:Stroke
keywords: Alzheimer’s disease; mortality; myocardial infarction; stroke