Cognitive impairment and outcomes in older adult survivors of acute myocardial infarction: Findings from the Translational Research Investigating Underlying disparities in acute Myocardial infarction Patients' Health Status registry - 16/11/11
, Kimberly J. Reid, MS b, Suzanne V. Arnold, MD, MHA b, John Spertus, MD, MPH b, Michael W. Rich, MD c, Patricia A. Pellikka, MD a, Mandeep Singh, MD a, Tracey Holsinger, MD d, Harlan M. Krumholz, MD, SM e, Eric D. Peterson, MD, MPH f, Karen P. Alexander, MD fRésumé |
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.
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| Frans J.J. Van de Werf, MD, PhD, served as guest editor for this article. |
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| Others' funding sources and affiliations: Dr Gharacholou is a participant in the NIH clinical research loan repayment program (1L30 AG034828-01) and is currently at the University of Wisconsin School of Medicine and Public Health, Division of Cardiology, Madison, WI 53792. |
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| The TRIUMPH study was supported by grant P50 HL077113 from the National Heart, Lung, and Blood Institute Specialized Center of Clinically Oriented Research in Cardiac Dysfunction and Disease. |
Vol 162 - N° 5
P. 860 - novembre 2011 Retour au numéro
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