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

Shahyar Gharacholou, Kimberly J. Reid, Suzanne V. Arnold, John Spertus, Michael W. Rich, Patricia Pellikka, Mandeep Singh, Tracey Holsinger, Harlan M. Krumholz, Eric D. Peterson, Karen P. Alexander

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalAmerican Heart Journal
Volume162
Issue number5
DOIs
StatePublished - Nov 2011

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Translational Medical Research
Health Status
Survivors
Dementia
Registries
Myocardial Infarction
Interviews
Cognition
Quality of Life
Survival
Cognitive Dysfunction
Referral and Consultation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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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. / Gharacholou, Shahyar; Reid, Kimberly J.; Arnold, Suzanne V.; Spertus, John; Rich, Michael W.; Pellikka, Patricia; Singh, Mandeep; Holsinger, Tracey; Krumholz, Harlan M.; Peterson, Eric D.; Alexander, Karen P.

In: American Heart Journal, Vol. 162, No. 5, 11.2011.

Research output: Contribution to journalArticle

Gharacholou, Shahyar ; Reid, Kimberly J. ; Arnold, Suzanne V. ; Spertus, John ; Rich, Michael W. ; Pellikka, Patricia ; Singh, Mandeep ; Holsinger, Tracey ; Krumholz, Harlan M. ; Peterson, Eric D. ; Alexander, Karen P. / 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. In: American Heart Journal. 2011 ; Vol. 162, No. 5.
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title = "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",
abstract = "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.",
author = "Shahyar Gharacholou and Reid, {Kimberly J.} and Arnold, {Suzanne V.} and John Spertus and Rich, {Michael W.} and Patricia Pellikka and Mandeep Singh and Tracey Holsinger and Krumholz, {Harlan M.} and Peterson, {Eric D.} and Alexander, {Karen P.}",
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T2 - Findings from the Translational Research Investigating Underlying disparities in acute Myocardial infarction Patients' Health Status registry

AU - Gharacholou, Shahyar

AU - Reid, Kimberly J.

AU - Arnold, Suzanne V.

AU - Spertus, John

AU - Rich, Michael W.

AU - Pellikka, Patricia

AU - Singh, Mandeep

AU - Holsinger, Tracey

AU - Krumholz, Harlan M.

AU - Peterson, Eric D.

AU - Alexander, Karen P.

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N2 - 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.

AB - 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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