Department of Medicine, Cook County Health, Chicago, Illinois, USA.
Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
J Am Geriatr Soc. 2023 Apr;71(4):1034-1046. doi: 10.1111/jgs.18120. Epub 2022 Nov 21.
As the population ages, clinicians increasingly encounter ischemic heart disease in patients with underlying dementia. Therefore, we quantified differences in inhospital adverse events and 30-day readmission rates among patients with and without dementia undergoing percutaneous coronary intervention (PCI).
Using the National Readmissions Database 2017-2018, we identified 755,406 index hospitalizations in which PCI was performed, of which 17,309 (2.3%) had a diagnosis of dementia. After propensity score matching patients with and without dementia, we assessed 30-day readmission and inhospital adverse events by Cox proportional hazards and logistic regression modeling and compared them with those of other common cardiac (pacemaker placement [PP]) and noncardiac (hip replacement surgery [HRS]) procedures.
Thirty-day readmission was significantly higher in patients with dementia than patients without dementia (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.60-1.74). Patients with dementia also experienced higher odds of delirium (odds ratio [OR] 4.37, CI 3.69-5.16), inhospital mortality (OR 1.15, CI 1.01-1.30), cardiac arrest (OR 1.19, CI 1.01-1.39), acute kidney injury (OR 1.30, CI 1.21-1.39), and fall (OR 2.51, CI 2.06-3.07). On multivariable Cox modeling, dementia independently predicted 30-day readmission (HR 1.14, CI 1.07-1.20). The higher readmission risk with PCI (11%) among those with dementia was similar to that of patients undergoing PP (10%), but lower than in those undergoing HRS (41%).
Patients with dementia who undergo PCI experience significantly increased rates of inhospital delirium, mortality, kidney injury, falls, and 30-day readmission. These adverse outcomes should be considered during shared decision-making with patients and their families.
随着人口老龄化，临床医生越来越多地在患有潜在痴呆症的患者中遇到缺血性心脏病。因此，我们量化了接受经皮冠状动脉介入治疗（PCI）的患者中有无痴呆症患者的住院期间不良事件和 30 天再入院率的差异。
使用 2017-2018 年全国再入院数据库，我们确定了 755406 例接受 PCI 的索引住院患者，其中 17309 例（2.3%）诊断为痴呆症。对有和无痴呆症的患者进行倾向评分匹配后，我们使用 Cox 比例风险和逻辑回归模型评估了 30 天再入院和住院期间不良事件，并将其与其他常见心脏（起搏器植入 [PP]）和非心脏（髋关节置换手术 [HRS]）手术进行了比较。
痴呆症患者的 30 天再入院率明显高于无痴呆症患者（风险比 [HR] 1.67，95%置信区间 [CI] 1.60-1.74）。痴呆症患者还经历了更高的谵妄（比值比 [OR] 4.37，CI 3.69-5.16）、住院期间死亡率（OR 1.15，CI 1.01-1.30）、心脏骤停（OR 1.19，CI 1.01-1.39）、急性肾损伤（OR 1.30，CI 1.21-1.39）和跌倒（OR 2.51，CI 2.06-3.07）的几率。在多变量 Cox 模型中，痴呆症独立预测了 30 天再入院（HR 1.14，CI 1.07-1.20）。痴呆症患者接受 PCI 的再入院风险（11%）与接受 PP 治疗的患者（10%）相似，但低于接受 HRS 治疗的患者（41%）。
接受 PCI 的痴呆症患者经历了显著增加的住院期间谵妄、死亡率、肾损伤、跌倒和 30 天再入院率。在与患者及其家属进行共同决策时，应考虑这些不良后果。
