Related Experiment Video
Updated: Jan 7, 2026
A Mouse Model for Vascular Cognitive Impairment and Dementia Based on Needle-guided Asymmetric Bilateral Common Carotid Artery Stenosis
Published on: November 22, 2024
Dementia is associated with higher mortality and worse patient-centered outcomes after complex and high-risk coronary
Khanjan B Shah1, Lingwei Xiang2, Samir K Shah3
1Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, FL, USA.
Insights
Patients with Alzheimer's dementia and related dementias (ADRD) undergoing complex high-risk indicated percutaneous coronary intervention (CHIP-PCI) face higher mortality and complications. ADRD patients also experience worse outcomes like longer hospital stays and higher discharge to higher care levels.
Area of Science:
- Cardiology
- Geriatric Medicine
- Neurology
Background:
- Complex high-risk indicated percutaneous coronary intervention (CHIP-PCI) is a critical procedure for patients with complex coronary artery disease and comorbidities.
- The aging population increases the prevalence of patients requiring CHIP-PCI, including those with Alzheimer's dementia and related dementias (ADRD).
- Outcomes of CHIP-PCI in patients with ADRD remain understudied, necessitating further investigation.
Purpose of the Study:
- To evaluate the impact of dementia status on the outcomes of CHIP-PCI.
- To compare the clinical and patient-centered outcomes of CHIP-PCI in patients with and without ADRD.
Main Methods:
- A comparative study of Medicare fee-for-service beneficiaries aged 66 years and older who underwent CHIP-PCI between July 2017 and December 2019.
- Analysis included 1-year mortality, 90-day major complications, readmissions, time-at-home ratio, and discharge to a higher level of care.
- Patients were stratified based on the presence or absence of ADRD diagnosis.
Main Results:
- Out of 8884 CHIP-PCI patients, 766 (8.6%) had ADRD. Patients with ADRD were older and more frail.
- ADRD patients exhibited significantly higher 1-year mortality (OR 1.34), 90-day major complications (OR 1.22), and readmissions (OR 1.27).
- ADRD patients were more likely to be discharged to a higher level of care (OR 1.81) and had lower time-at-home ratios (MD -5.48).
Conclusions:
- Patients with ADRD undergoing CHIP-PCI experience poorer clinical outcomes, including increased mortality and complications.
- ADRD is associated with significantly worse patient-centered outcomes, specifically reduced time at home and increased need for higher levels of care post-discharge.
- These findings underscore the importance of shared decision-making and goal-concordant care planning for CHIP-PCI patients with ADRD, involving patients, families, and healthcare providers.
Objectives:
The aims of this study were to assess whether dementia status influences outcomes of complex high-risk indicated percutaneous coronary intervention (CHIP-PCI).
Background:
CHIP-PCI is a type of coronary artery stenting procedure for patients with anatomically complex coronary artery disease and significant medical comorbidities. As the population ages, more patients will require CHIP-PCI including those with Alzheimer's dementia and related dementias (ADRD). Outcomes of CHIP-PCI in patients with ADRD are underexplored.
Methods:
We compared outcomes of Medicare fee-for-service (FFS) beneficiaries 66 years or older with and without ADRD who underwent CHIP-PCI from July 1, 2017 to December 31, 2019. The primary clinical outcome was 1-year mortality, and secondary clinical outcomes were complications and readmissions. Patient-centered outcomes were time-at-home ratio and discharge to higher level of care.
Results:
8884 patients undergoing CHIP-PCI met study criteria, and 766 (8.6 %) patients carried a diagnosis of ADRD. Patients with ADRD were more likely to be older (81.2 vs 77.5, p < 0.001) and frail (52.1 % vs. 27.3 %, p < 0.001). 1-year mortality was higher among patients with ADRD (OR 1.34, 95 % CI 1.14-1.57) as was 90-day major complications (OR 1.22, 95 % CI 1.03-1.43) and readmissions (OR 1.27, 95 % CI 1.07-1.50). Patients with ADRD were more likely to be discharged to a higher level of care (OR 1.81, 95 % CI 1.48-2.22) and have lower time-at-home ratios (Mean Difference -5.48, 95 % CI -9.24 to -2.45).
Conclusions:
Patients with ADRD demonstrate higher 1-year mortality as well as major complications. They demonstrate especially poor time-at-home ratio and risk for discharge to a higher level of care. These data should be used by patients, their families, and physicians to facilitate goal-concordant care.
More Related Videos
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
04:30A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:23Atherosclerosis IV: Nursing Management
01:30Dementia
The progression of dementia is generally gradual....
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Coronary Artery Disease III: Clinical Manifestations
01:30Acute Coronary Syndrome I: Introduction