Li Yunfei, Babazono Akira, Jamal Aziz, Liu Ning, Yamao Reiko
Department of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Health Administration Program, Faculty of Business & Management, Universiti Teknologi Mara, Selangor, Malaysia.
Clin Epidemiol. 2021 Sep 29;13:883-892. doi: 10.2147/CLEP.S327404. eCollection 2021.
Acute myocardial infarction (AMI) management strategies, involving treatment and post-care, are much more difficult for patients with dementia. This study investigated the factors influencing the use of invasive procedures and long-term care in the management strategies for AMI patients with dementia and the factors associated with these patients' survival.
This multilevel study combined information from two databases, namely later-stage elderly healthcare insurance and long-term care insurance claims, from 2013 to 2019. Of 214,963 individuals with dementia, we identified 13,593 patients with AMI. The primary outcomes were the use of invasive procedures for treatment and long-term care for post-care management. Survival outcomes were also measured over a 6-year period, adjusting for individual- and regional-level characteristics in multilevel models.
A total of 1954 (14.38%) individuals received an invasive procedure during treatment, and 7850 (87.18%) used long-term care for post-care management after AMI. After multivariate adjustment, patients aged ≥ 85 years and women were less likely to receive invasive procedures and more likely to use long-term care. Patients undergoing invasive procedures had a lower use of long-term care. Better survival outcome was significantly associated with invasive management and long-term care, regardless of the type of care.
Age and sex determine the use of invasive procedures and long-term care after AMI among patients with dementia. AMI patients with dementia receiving invasive procedures and long-term care had better survival outcomes.
对于患有痴呆症的患者，急性心肌梗死（AMI）的管理策略，包括治疗和后期护理，要困难得多。本研究调查了影响痴呆症AMI患者管理策略中侵入性手术使用和长期护理的因素，以及与这些患者生存相关的因素。
这项多层次研究结合了2013年至2019年两个数据库的信息，即后期老年医疗保险和长期护理保险理赔数据。在214,963名痴呆症患者中，我们确定了13,593名AMI患者。主要结局是治疗中侵入性手术的使用和后期护理管理的长期护理。还在6年期间测量了生存结局，并在多层次模型中对个体和地区层面的特征进行了调整。
共有1954名（14.38%）个体在治疗期间接受了侵入性手术，7850名（87.18%）在AMI后使用长期护理进行后期护理管理。经过多变量调整后，年龄≥85岁的患者和女性接受侵入性手术的可能性较小，使用长期护理的可能性较大。接受侵入性手术的患者长期护理的使用率较低。无论护理类型如何，更好的生存结局与侵入性管理和长期护理显著相关。
年龄和性别决定了痴呆症患者AMI后侵入性手术和长期护理的使用情况。接受侵入性手术和长期护理的痴呆症AMI患者有更好的生存结局。
