Alzheimer’s Disease and Related Dementias is Associated with Worse Clinical and Patient-centered Outcomes in Patient Admitted for Heart Failure

Background: The aims of this study are to assess clinical and patient-centered outcomes following admission for HF as stratified by ADRD status. Methods: We identified patients 65 years or older in the OneFlorida+ data trust with first admission for HF between October 1, 2015 and December 31, 2022. ICD-10 diagnoses codes were used to identify HF, ADRD, and relevant comorbidities. Exclusion criteria were admission with ST-elevation myocardial infarction (STEMI) or shock. The primary clinical outcome was all-cause 1-year mortality, and the secondary clinical outcome was 90-day readmissions. Patient-centered outcomes were length of stay and discharge home. Results: 22,342 patients with first HF hospitalization during the study period were identified. Of these, 5,261 (23.5%) patients carried a diagnosis of ADRD. Patients with ADRD were more likely to be women (57.7% vs. 53.1%, p<0.05) and Black (21.1% vs. 14.6%, p<0.05). 1-year mortality was higher in patients with ADRD (HR 1.22, 95% CI 1.10-1.36, p < 0.005) as was 90-day readmissions (HR 1.23, 95% CI 1.18-1.28, p <0.005). Patients with ADRD demonstrated longer lengths of stays (5.7 vs. 5.4 days, p <0.005) and were less likely to be discharged home (OR .81, 95% CI 0.77-0.84, p<0.001). Conclusion: Patients with ADRD hospitalized for HF demonstrate higher 1-year mortality and 90-day readmissions. Patient-centered outcomes are also worse in patients with ADRD, with longer lengths of stay and are less discharge home. These findings should be used to identify research priorities and to facilitate advanced care planning in patients with ADRD and HF.