TY - JOUR
T1 - Cognitive impairment and outcomes in older adult survivors of acute myocardial infarction
T2 - Findings from the Translational Research Investigating Underlying disparities in acute Myocardial infarction Patients' Health Status registry
AU - Gharacholou, S. Michael
AU - Reid, Kimberly J.
AU - Arnold, Suzanne V.
AU - Spertus, John
AU - Rich, Michael W.
AU - Pellikka, Patricia A.
AU - Singh, Mandeep
AU - Holsinger, Tracey
AU - Krumholz, Harlan M.
AU - Peterson, Eric D.
AU - Alexander, Karen P.
N1 - Funding Information:
Dr Spertus developed and owns the copyrights for the SAQ. Dr Rich reports research grants from Astellas Pharma US ($10,000). The remaining authors report no disclosures (S.M.G., K.J.R., S.V.A., P.A.P., M.S., T.H., H.M.K., E.D.P., and K.P.A.).
PY - 2011/11
Y1 - 2011/11
N2 - Background: Cognitive impairment without dementia (CIND) and acute myocardial infarction (AMI) are prevalent in older adults; however, the association of CIND with outcomes after AMI is unknown. Methods: We used a multicenter registry to study 772 patients ≤65 years with AMI, enrolled between April 2005 and December 2008, who underwent cognitive function assessment with the Telephone Interview for Cognitive Status-modified (TICS-m) 1 month after AMI. Patients were categorized by cognitive status to describe characteristics and in-hospital treatment, including quality of life and survival 1 year after AMI. Results: Mean age was 73.2 ± 6.3 years; 58.5% were men, and 78.2% were white. Normal cognitive function (TICS-m >22) was present in 44.4%; mild CIND (TICS-m 19-22) in 29.8%; and moderate/severe CIND (TICS-m <19) in 25.8% of patients. Rates of hypertension (72.6%, 77.4%, and 81.9%), cerebrovascular accidents (3.5%, 7.0%, and 9.0%), and myocardial infarction (20.1%, 22.2%, and 29.6%) were higher in those with lower TICS-m scores (P <.05 for comparisons). AMI medications were similar by cognitive status; however, CIND was associated with lower cardiac catheterization rates (P =.002) and cardiac rehabilitation referrals (P <.001). Patients with moderate/severe CIND had higher risk-adjusted 1-year mortality that was nonstatistically significant (adjusted hazard ratio 1.97, 95% CI 0.99-3.94, P =.054; referent normal, TICS-m >22). Quality of life across cognitive status was similar at 1 year. Conclusions: Most older patients surviving AMI have measurable CIND. Cognitive impairment without dementia was associated with less invasive care, less referral and participation in cardiac rehabilitation, and worse risk-adjusted 1-year survival in those with moderate/severe CIND, making it an important condition to consider in optimizing AMI care.
AB - Background: Cognitive impairment without dementia (CIND) and acute myocardial infarction (AMI) are prevalent in older adults; however, the association of CIND with outcomes after AMI is unknown. Methods: We used a multicenter registry to study 772 patients ≤65 years with AMI, enrolled between April 2005 and December 2008, who underwent cognitive function assessment with the Telephone Interview for Cognitive Status-modified (TICS-m) 1 month after AMI. Patients were categorized by cognitive status to describe characteristics and in-hospital treatment, including quality of life and survival 1 year after AMI. Results: Mean age was 73.2 ± 6.3 years; 58.5% were men, and 78.2% were white. Normal cognitive function (TICS-m >22) was present in 44.4%; mild CIND (TICS-m 19-22) in 29.8%; and moderate/severe CIND (TICS-m <19) in 25.8% of patients. Rates of hypertension (72.6%, 77.4%, and 81.9%), cerebrovascular accidents (3.5%, 7.0%, and 9.0%), and myocardial infarction (20.1%, 22.2%, and 29.6%) were higher in those with lower TICS-m scores (P <.05 for comparisons). AMI medications were similar by cognitive status; however, CIND was associated with lower cardiac catheterization rates (P =.002) and cardiac rehabilitation referrals (P <.001). Patients with moderate/severe CIND had higher risk-adjusted 1-year mortality that was nonstatistically significant (adjusted hazard ratio 1.97, 95% CI 0.99-3.94, P =.054; referent normal, TICS-m >22). Quality of life across cognitive status was similar at 1 year. Conclusions: Most older patients surviving AMI have measurable CIND. Cognitive impairment without dementia was associated with less invasive care, less referral and participation in cardiac rehabilitation, and worse risk-adjusted 1-year survival in those with moderate/severe CIND, making it an important condition to consider in optimizing AMI care.
UR - http://www.scopus.com/inward/record.url?scp=81255214779&partnerID=8YFLogxK
U2 - 10.1016/j.ahj.2011.08.005
DO - 10.1016/j.ahj.2011.08.005
M3 - Article
C2 - 22093202
AN - SCOPUS:81255214779
SN - 0002-8703
VL - 162
SP - 860-869.e1
JO - American heart journal
JF - American heart journal
IS - 5
ER -