Mild Cognitive Impairment and Receipt of Treatments for Acute Myocardial Infarction in Older Adults
Mild Cognitive Impairment and Receipt of Treatments for Acute Myocardial Infarction in Older Adults
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DOI：
10.1007/s11606-019-05155-8
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发表时间：
2020-01-01
影响因子：
5.7
通讯作者：
Nallamothu, Brahmajee K.
中科院分区：
文献类型：
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作者：
Levine, Deborah A.;Langa, Kenneth M.;Nallamothu, Brahmajee K.
背景轻度认知损害(MCI)的老年人应在有指征的情况下接受循证治疗。提供者和患者可能高估了MCI患者患痴呆症的风险，导致潜在的治疗不足。然而，先前存在的MCI与接受循证治疗之间的关联尚不确定。目的比较老年MCI患者与认知正常患者对急性心肌梗死(AMI)治疗的接受情况。使用具有全国代表性的健康和退休研究、联邦医疗保险和美国医院协会的数据设计前瞻性研究。受试者为609名65岁或以上的成年人，年龄在2000-2011年间因急性心肌梗死住院，并在2012年前有MCI(定义为认知状态评分为7-11的改良电话访谈)和正常认知(评分为12-27)。主要措施：急性心肌梗死患者入院30天内接受心导管和冠状动脉血运重建，1年内接受心脏康复治疗。关键结果：在存活的急性心肌梗死患者中，19.2%的患者有MCI(55.6%为女性，44.4%为男性，平均年龄为82.3[7.5]岁)，80.8%的患者认知功能正常(45.7%为女性，54.3%为男性，平均年龄为77.1[7.1]岁)。与认知正常的患者相比，有轻度认知障碍的急性心肌梗死患者接受心导管术(50%比77%；P<；0.001)、冠状动脉血运重建(29%比63%；P&t；0.001)和心脏康复(9%比22%；P=0.001)的可能性显著减少。在调整了患者和医院因素后，既往存在的心肌梗死仍然与较少使用心脏插管(调整后的风险比，0.65；95%可信区间，0.48-0.89；P=0.007)和冠状动脉血运重建(调整后的风险比，0.55；95%可信区间，0.37-0.81；P=.003)有关，但与心脏康复(心脏康复，1.01；95%可信区间，0.49-2.07；P=0.98)无关。结论既往MCI与心导管术和冠状动脉血运重建术的使用率较低有关，但与心脏康复无关。
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.