30-Day Mortality after Cardiovascular Events in Persons with or without Alzheimer's Disease

Persons with Alzheimer's disease (AD) have been suggested to receive suboptimal treatment. We studied the 30-day mortality after ischemic stroke, hemorrhagic stroke, or myocardial infarction in individuals with or without AD.

An exposure matched cohort of all Finnish community-dwellers diagnosed with clinically verified AD in 2005-2012 (n = 73,005) and 1-4 matched comparison persons/AD-affected person (n = 215,449). Data on 30-day mortality after ischemic stroke (n = 16,419; deaths: n = 2,748), hemorrhagic stroke (n = 3,570; deaths: n = 1,224), and myocardial infarction (n = 15,304; deaths: n = 3,804) were obtained from the National Hospital Discharge register. The main analyses were restricted to first-ever events.

Persons with AD had slightly higher 30-day mortality after ischemic stroke (adjusted HR 1.36, 95% Confidence interval (CI) 1.24,1.49), hemorrhagic stroke (adjusted HR 1.11, 95% CI 0.98,1.25), or myocardial infarction (adjusted HR, 1.40, 9% CI 1.30,1.51). The associations were not affected by age, gender, or co-morbidities and remained similar when patients with previous ischemic strokes or infarctions were included. The absolute risk increase in 30-day mortality after ischemic or hemorrhagic stroke and myocardial infarction were 4.9% (95% CI 3.3,6.5), 3.3% (95% CI - 1.6,8.2), and 7.5% (95% CI 5.0,10.0), respectively.

Although the 30-day mortality was somewhat higher in the AD cohort, the absolute differences were small indicating that acute treatment was not notably inferior in AD patients. The slightly higher mortality was not explained by co-morbidities but may reflect the higher mortality of AD persons in general, or treatment practice of patients with severe cognitive impairment.