The Effect of Dementia on Outcomes and Process of Care for Medicare Beneficiaries Admitted with Acute Myocardial Infarction

Objectives: To determine differences in mortality after admission for acute myocardial infarction (AMI) and in use of noninvasive and invasive treatments for AMI between patients with and without dementia. Design: Retrospective chart review. Setting: Cooperative Cardiovascular Project. Patients: Medicare patients admitted for AMI (N=129,092) in 1994 and 1995. Measurements: Dementia noted on medical chart as history of dementia, Alzheimer's disease, chronic confusion, or senility. Outcome measures included mortality at 30 days and 1‐year postadmission; use of aspirin, beta‐blocker, angiotensin‐converting enzyme (ACE) inhibitor, thrombolytic therapy, cardiac catheterization, coronary angioplasty, and cardiac bypass surgery compared by dementia status. Results: Dementia was associated with higher mortality at 30 days (relative risk (RR)=1.16, 95% confidence interval (CI)=1.09–1.22) and at 1‐year postadmission (RR=1.18, 95% CI=1.13–1.23). There were few to no differences in the use of aspirin and beta‐blockers between patients with and without a history of dementia. Patients with a history of dementia were less likely to receive ACE inhibitors during the stay (RR=0.89, 95% CI=0.86–0.93) or at discharge (RR=0.90, 95% CI=0.86–0.95), thrombolytic therapy (RR=0.82, 95% CI=0.74–0.90), catheterization (RR=0.51, 95% CI=0.47–0.55), coronary angioplasty (RR=0.58, 95% CI=0.51–0.66), and cardiac bypass surgery (RR=0.41, 95% CI=0.33–0.50) than patients without a history of dementia. Conclusion: The results imply that the presence of dementia had a major effect on mortality and care patterns for this condition.