老年人的轻度认知障碍与急性心肌梗死治疗的接受情况
Mild Cognitive Impairment and Receipt of Treatments for Acute Myocardial Infarction in Older Adults.
作者信息
Levine Deborah A, Langa Kenneth M, Galecki Andrzej, Kabeto Mohammed, Morgenstern Lewis B, Zahuranec Darin B, Giordani Bruno, Lisabeth Lynda D, Nallamothu Brahmajee K
机构信息
Department of Internal Medicine, University of Michigan (U-M), North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor, MI, 48109-2800, USA.
Department of Neurology and Stroke Program, U-M, Ann Arbor, MI, USA.
出版信息
J Gen Intern Med. 2020 Jan;35(1):28-35. doi: 10.1007/s11606-019-05155-8. Epub 2019 Aug 13.
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.
背景
患有轻度认知障碍（MCI）的老年人在有指征时应接受循证治疗。医疗服务提供者和患者可能高估了MCI患者患痴呆症的风险，从而导致潜在的治疗不足。然而，既往存在的MCI与循证治疗的接受情况之间的关联尚不确定。
目的
比较既往存在MCI的老年人与认知正常患者在急性心肌梗死（AMI）治疗方面的接受情况。
设计
一项前瞻性研究，使用具有全国代表性的健康与退休研究、医疗保险和美国医院协会的数据。
参与者
2000年至2011年间因AMI住院且在2012年仍被随访的609名65岁及以上成年人，其中包括既往存在MCI（定义为改良认知状态电话访谈评分为7 - 11分）和认知正常（评分为12 - 27分）的患者。
主要测量指标
AMI住院后30天内接受心导管插入术和冠状动脉血运重建以及1年内接受心脏康复治疗的情况。
关键结果
在AMI幸存者中，19.2%既往存在MCI（55.6%为女性，44.4%为男性，平均[标准差]年龄为82.3[7.5]岁），80.8%认知正常（45.7%为女性，54.3%为男性，平均年龄为77.1[7.1]岁）。既往存在MCI的AMI幸存者接受心导管插入术（50%对77%；P < 0.001）、冠状动脉血运重建（29%对63%；P < 0.001）和心脏康复治疗（9%对22%；P = 0.001）的可能性明显低于认知正常的幸存者。在对患者和医院因素进行调整后，既往存在的MCI仍与较低的心导管插入术使用率（调整后风险比[aHR]，0.65；95%置信区间[CI]，0.48 - 0.89；P = 0.007）和冠状动脉血运重建率（aHR，0.55；95% CI，0.37 - 从0.81；P = 0.003）相关，但与心脏康复治疗无关（aHR，1.01；95% CI，0.49 - 2.07；P = 0.98）。
结论
既往存在的MCI与AMI后较低的心导管插入术和冠状动脉血运重建使用率相关，但与心脏康复治疗无关。
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