Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco.
Associate Editor, JAMA Neurology.
JAMA Neurol. 2023 Nov 1;80(11):1166-1173. doi: 10.1001/jamaneurol.2023.3490.
Results of amyloid positron emission tomography (PET) have been shown to change the management of patients with mild cognitive impairment (MCI) or dementia who meet Appropriate Use Criteria (AUC).
To determine if amyloid PET is associated with reduced hospitalizations and emergency department (ED) visits over 12 months in patients with MCI or dementia.
DESIGN, SETTING, AND PARTICIPANTS: This nonrandomized controlled trial analyzed participants in the Imaging Dementia-Evidence for Amyloid Scanning (IDEAS) study, an open-label, multisite, longitudinal study that enrolled participants between February 2016 and December 2017 and followed up through December 2018. These participants were recruited at 595 clinical sites that provide specialty memory care across the US. Eligible participants were Medicare beneficiaries 65 years or older with a diagnosis of MCI or dementia within the past 24 months who met published AUC for amyloid PET. Each IDEAS study participant was matched to a control Medicare beneficiary who had not undergone amyloid PET. Data analysis was conducted on December 13, 2022.
Participants underwent amyloid PET at imaging centers.
The primary end points were the proportions of patients with 12-month inpatient hospital admissions and ED visits. One of 4 secondary end points was the rate of hospitalizations and rate of ED visits in participants with positive vs negative amyloid PET results. Health care use was ascertained from Medicare claims data.
The 2 cohorts (IDEAS study participants and controls) each comprised 12 684 adults, including 6467 females (51.0%) with a median (IQR) age of 77 (73-81) years. Over 12 months, 24.0% of the IDEAS study participants were hospitalized, compared with 25.1% of the matched control cohort, for a relative reduction of -4.49% (97.5% CI, -9.09% to 0.34%). The 12-month ED visit rates were nearly identical between the 2 cohorts (44.8% in both IDEAS study and control cohorts) for a relative reduction of -0.12% (97.5% CI, -3.19% to 3.05%). Both outcomes fell short of the prespecified effect size of 10% or greater relative reduction. Overall, 1467 of 6848 participants (21.4%) with positive amyloid PET scans were hospitalized within 12 months compared with 1081 of 4209 participants (25.7%) with negative amyloid PET scans (adjusted odds ratio, 0.83; 95% CI, 0.78-0.89).
Results of this nonrandomized controlled trial showed that use of amyloid PET was not associated with a significant reduction in 12-month hospitalizations or ED visits. Rates of hospitalization were lower in patients with positive vs negative amyloid PET results.
已证明淀粉样蛋白正电子发射断层扫描 (PET) 的结果改变了符合适当使用标准 (AUC) 的轻度认知障碍 (MCI) 或痴呆患者的管理。
确定在 MCI 或痴呆患者中，淀粉样蛋白 PET 是否与 12 个月内住院和急诊 (ED) 就诊次数减少相关。
设计、地点和参与者：这项非随机对照试验分析了 Imaging Dementia-Evidence for Amyloid Scanning (IDEAS) 研究的参与者，该研究是一项开放标签、多站点、纵向研究，于 2016 年 2 月至 2017 年 12 月间招募参与者，并随访至 2018 年 12 月。这些参与者是在美国各地提供专业记忆护理的 595 个临床站点招募的。符合条件的参与者是年龄在 65 岁或以上的 Medicare 受益人，在过去 24 个月内被诊断为 MCI 或痴呆，并符合淀粉样蛋白 PET 的已发表 AUC。每位 IDEAS 研究参与者都与未接受淀粉样蛋白 PET 的对照 Medicare 受益人相匹配。数据分析于 2022 年 12 月 13 日进行。
参与者在影像中心接受淀粉样蛋白 PET 检查。
主要终点是 12 个月内住院和 ED 就诊的患者比例。四个次要终点之一是阳性与阴性淀粉样蛋白 PET 结果患者的住院率和 ED 就诊率。通过 Medicare 理赔数据确定医疗保健的使用情况。
两个队列 (IDEAS 研究参与者和对照组) 各包括 12684 名成年人，其中包括 6467 名女性 (51.0%)，中位 (IQR) 年龄为 77(73-81) 岁。在 12 个月期间，24.0%的 IDEAS 研究参与者住院，而匹配对照组队列的住院率为 25.1%，相对减少了 -4.49%(97.5%CI，-9.09%至 0.34%)。两个队列的 12 个月 ED 就诊率几乎相同 (IDEAS 研究和对照组队列分别为 44.8%)，相对减少了 -0.12%(97.5%CI，-3.19%至 3.05%)。这两个结果都没有达到预先规定的 10%或更高的相对减少效果大小。总体而言，在 6848 名有阳性淀粉样蛋白扫描结果的参与者中，有 1467 名(21.4%)在 12 个月内住院，而在 4209 名有阴性淀粉样蛋白扫描结果的参与者中，有 1081 名(25.7%)住院(校正优势比，0.83;95%CI，0.78-0.89)。
这项非随机对照试验的结果表明，使用淀粉样蛋白 PET 与 12 个月内住院或 ED 就诊次数的显著减少无关。阳性与阴性淀粉样蛋白 PET 结果患者的住院率较低。
