Dementia: a barrier to receiving percutaneous coronary intervention for elderly patients with ST-elevated myocardial infarction

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 hospita...

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Bibliographic Details
Published in:International journal of geriatric psychiatry 2014-09, Vol.29 (9), p.906-914
Main Authors: Chanti-Ketterl, Marianne, Pathak, Elizabeth Barnett, Andel, Ross, Mortimer, James A.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Angioplasty
Biological and medical sciences
catheterization
Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases
Dementia
Dementia - complications
disparity
elderly
Female
Florida
General aspects
Geriatric psychiatry
Geriatrics
Healthcare Disparities - statistics & numerical data
Heart attacks
Humans
Intubation
Male
Medical diagnosis
Medical sciences
Medical treatment
Multivariate Analysis
Myocardial Infarction - therapy
Neurology
PCI
Percutaneous Coronary Intervention - statistics & numerical data
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Retrospective Studies
Risk Factors
STEMI
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Summary: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. Copyright © 2014 John Wiley & Sons, Ltd.
ISSN:0885-6230
1099-1166
DOI:10.1002/gps.4078