Dementia: a barrier to receiving percutaneous coronary intervention for elderly patients with ST-elevated myocardial
Marianne Chanti-Ketterl1, Elizabeth Barnett Pathak, Ross Andel
1School of Aging Studies, University of South Florida, Tampa, FL, USA.
Insights
Older adults with dementia are significantly less likely to undergo cardiac catheterization for ST-elevated myocardial infarction (STEMI). This limits their access to potentially life-saving treatments like percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG).
Area of Science:
- Cardiology
- Geriatrics
- Neurology
Background:
- Percutaneous coronary intervention (PCI) is a primary treatment for ST-elevated myocardial infarction (STEMI).
- Dementia is a growing concern in the elderly population, impacting healthcare decisions and outcomes.
- Evaluating treatment disparities in STEMI patients with dementia is crucial for equitable care.
Purpose of the Study:
- To investigate the association between dementia and the utilization of diagnostic cardiac catheterization in STEMI patients aged 65 and older.
- To determine if dementia influences the likelihood of receiving PCI or coronary artery bypass graft (CABG) among STEMI patients.
Main Methods:
- Retrospective analysis of Florida inpatient data (2006-2007) for STEMI patients ≥65 years old.
- Dementia diagnosis identified using ICD-9 codes.
- Statistical analysis, including relative risk (RR) calculations, adjusted for demographic factors.
Main Results:
- STEMI patients with dementia (3%) were significantly less likely to undergo cardiac catheterization (42% vs. higher for non-demented).
- Among those catheterized, dementia did not affect PCI or CABG rates.
- Factors reducing catheterization in dementia patients included older age and later hospital arrival; hyperlipidemia increased likelihood.
Conclusions:
- Dementia is associated with substantially lower rates of diagnostic cardiac catheterization in elderly STEMI patients.
- This disparity may restrict access to optimal reperfusion therapies, including PCI and CABG.
- Further research is needed to address barriers and ensure equitable care for STEMI patients with cognitive impairment.
Objective:
Percutaneous coronary intervention (PCI) is the first line of treatment for ST-elevated myocardial infarction (STEMI). This study evaluates the role of dementia in diagnostic cardiac catheterization (to receive PCI) in STEMI patients ≥65 years old admitted to high annual volume PCI hospitals.
Methods:
Participants were registered in Florida's comprehensive inpatient surveillance system for the years 2006-2007 with principal diagnosis of STEMI. Dementia was defined using ICD-9 codes for presenile, senile, and Alzheimer's type dementia.
Results:
Data from 8331 STEMI patients were used. Of these, 77.2% were catheterized, 67.2% received PCI, and 9.3% had coronary artery bypass graft (CABG). The mean age of the cohort was 76.3 years (SD 7.8 years.); with 43.3% female, 83.4% white, 4.6% black, and 12% Hispanic/other. Of the 248 (3%) patients with dementia, 42% were catheterized. After adjustment for age, gender, and race/ethnicity, patients with dementia were less likely to be catheterized (RR 0.30, 95% CI 0.30-0.50) than non-demented patients. However, among patients who were catheterized, there was no difference in the use of PCI or CABG for patients with versus without dementia (p = 0.56). Of those with dementia, being older and arriving to the hospital in the afternoon were associated with lower likelihood of being catheterized (RR 0.08, 95% CI 0.02-0.28, and RR 0.30, 95% CI 0.10-0.88, respectively). However, having hyperlipidemia increased the probability of catheterization (RR 3.60, 95% CI 1.86-6.98).
Conclusion:
ST-elevated myocardial infarction patients with dementia were much less likely to receive diagnostic cardiac catheterization, thereby limiting the possibility for receiving optimal care including PCI or CABG.
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