Baseline Dementia Prevalence and Subtypes in Older Adults Hospitalized With Acute Coronary Syndrome: A Multicenter Study From a Large Integrated Health Care Delivery System.

Q: What are the key findings of this study?

Among older adults hospitalized with acute coronary syndrome, the overall baseline prevalence of dementia was 5.9%, with significantly lower rates among those undergoing coronary revascularization (1.9%) compared to those managed without revascularization (7.9%).

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Acute Coronary Syndrome (n=26749). Intervention: Coronary revascularization vs. No coronary revascularization. Primary outcome: Baseline prevalence of documented dementia (p=<.001).

Q: What does this research mean for the field?

One in 17 older adults hospitalized with acute coronary syndrome has a documented baseline diagnosis of dementia, with prevalence varying substantially by revascularization strategy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To examine the baseline prevalence and specific subtypes of dementia among older adults hospitalized with acute coronary syndrome across different coronary revascularization strategies.

Ashok Krishnaswami; Amanda Jain; Howard Dinh; Richard V Ha; Wynnelena C Canio; Michael G Nanna; Alicia Romero; Paola Gilsanz; Neelum T Aggarwal; Michelle M Mielke; Mathew S Maurer; Janine Yang; E Shin; Divyesh M Patel; Abdulla A. Damluji; Ahmed Shah

doi:10.7812/tpp/25.159

March 10, 2026

Baseline Dementia Prevalence and Subtypes in Older Adults Hospitalized With Acute Coronary Syndrome: A Multicenter Study From a Large Integrated Health Care Delivery System.

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Key result

Coronary revascularization in older ACS patients is linked to ~6 percentage points lower dementia prevalence.

P<.001
n=26,749

Figures

Key Points

To examine the baseline prevalence and specific subtypes of dementia among older adults hospitalized with acute coronary syndrome across different coronary revascularization strategies.
Cross-sectional analysis of a longitudinal cohort of 26,749 members aged ≥ 65 years hospitalized with acute coronary syndrome between January 2010 and December 2020 within Kaiser Permanente Northern California.
Identification of dementia diagnoses and clinical subtypes using International Classification of Diseases 9/10 diagnostic codes.
Comparison of baseline dementia prevalence across management approaches: percutaneous coronary intervention, coronary artery bypass grafting, or no revascularization.
Baseline dementia prevalence was 5.9% overall (n = 1572), with significant variation across revascularization groups (P < .001): 7.9% in nonrevascularized patients, 2.0% for percutaneous coronary intervention, and 0.6% (0.62%) for coronary artery bypass grafting.
Alzheimer's disease was the most common subtype (85.7%, n = 1347), followed by vascular dementia (5.7%, n = 90), Lewy body or Parkinson's-related dementia (3.7%, n = 58), unspecified dementia (3.9%, n = 62), and frontotemporal dementia (1.0%, n = 15).
Dementia subtype distribution was similar between revascularized (87.6% Alzheimer's) and nonrevascularized patients (85.5% Alzheimer's, P = .51).

Study Design

Type

Cross-Sectional (n=26,749)

Multicenter

Yes

Structured PICO

P

Population

26,749 older adults (aged ≥ 65 years) hospitalized with acute coronary syndrome in a large integrated healthcare system, evaluated at baseline for documented dementia prevalence.

E

Exposure

Coronary revascularization (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) during index hospitalization

C

Comparator

No coronary revascularization during index hospitalization

O

Outcome

Baseline prevalence and subtypes of dementia

Main Result

Absolute Event Rate: 1.9% vs 7.9%

p-value: p=<.001

Among older adults hospitalized with acute coronary syndrome, approximately 1 in 17 had a baseline diagnosis of dementia, and this population was disproportionately managed with non-invasive strategies.

Limitations

Dementia diagnoses were based on existing electronic health record documentation, which may underestimate the true prevalence.
Patients with severe dementia may not have been hospitalized for ACS, causing potential selection bias.
Study did not address the epidemiology of minor cognitive impairment within the ACS cohort.
Variables such as frailty, caregiver support, and goals of care were not captured.
May not have captured the true incidence of dementia subtypes due to reliance on ICD codes.
Dementia diagnoses were based on electronic health record documentation, which may have altered the true prevalence
Did not address the epidemiology of minor cognitive impairment within the ACS cohort
Patients with severe dementia may not have been hospitalized for ACS
Did not capture variables such as frailty, caregiver support, and goals of care
May not have captured the true incidence of dementia subtypes due to reliance on ICD codes

Implication

Dementia prevalence varies by revascularization strategy in older ACS patients; may reflect selection and leaves open effects on eligibility or outcomes.

Abstract

BACKGROUND: Dementia is increasingly common among older adults (≥ 65 years) and is associated with poor outcomes. However, little is known about its baseline prevalence in patients hospitalized with acute coronary syndrome (ACS), particularly across revascularization strategies. METHODS: The authors conducted a cross-sectional analysis from a current longitudinal cohort study of Kaiser Permanente Northern California members hospitalized with ACS between January 2010 and December 2020. Dementia diagnoses and subtypes were identified using International Classification of Diseases 9/10 codes. Baseline prevalence was compared across revascularization strategies: percutaneous coronary intervention, coronary artery bypass grafting, or no revascularization. RESULTS: < .001). Dementia prevalence was 2.0% for percutaneous coronary intervention, 0.6% for coronary artery bypass grafting, and 7.9% for no revascularization. Alzheimer's disease was the most common subtype (85.7%), followed by vascular (5.7%), Lewy body/Parkinson's (3.7%), frontotemporal (1.0%), and unspecified types (3.9%). CONCLUSION: One in 17 older adults hospitalized with ACS had a documented diagnosis of dementia at baseline, with substantial variation by revascularization strategy. These findings highlight the baseline burden of dementia in this high-risk population and support the need for future research on the incidence and progression of cognitive impairment after ACS.

Discussion

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Cite This Study

Krishnaswami et al. (2026) conducted a cross-sectional in Acute Coronary Syndrome (n=26,749). Coronary revascularization vs. No coronary revascularization was evaluated on Baseline prevalence of documented dementia (p=<.001). Among older adults hospitalized with acute coronary syndrome, the overall baseline prevalence of dementia was 5.9%, with significantly lower rates among those undergoing coronary revascularization (1.9%) compared to those managed without revascularization (7.9%).

synapsesocial.com/papers/69b25b4996eeacc4fcec9d5c https://doi.org/10.7812/tpp/25.159

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Baseline Dementia Prevalence and Subtypes in Older Adults Hospitalized With Acute Coronary Syndrome: A Multicenter Study From a Large Integrated Health Care Delivery System.

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Baseline Dementia Prevalence and Subtypes in Older Adults Hospitalized With Acute Coronary Syndrome: A Multicenter Study From a Large Integrated Health Care Delivery System.

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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