Abstract
Introduction: The average Medicare beneficiary with HFrEF is now 80 years old. Alzheimer’s Disease and Related Dementias (ADRD) is more common among older adults. Yet, to date the rate of ADRD in HFrEF has not been well studied. This is important because the treatment of HFrEF relies on a complex medication regimen and often-challenging lifestyle modifications, things that are particularly difficult in the setting of concurrent cognitive impairment. The aim of this study is to determine the prevalence and outcomes of patients with concurrent HFrEF and ADRD (HF+ADRD). Methods: We used 100% Medicare Parts A and B and a random 40% sample of Part D to create a cohort of 397,680 fee-for-service beneficiaries with ≥1 hospitalization for HFrEF between 2012 and 2018. We required 1 year of FFS before and after discharge to capture comorbidities and measure outcomes over time. We used previously validated ICD-9/10 codes to define ADRD. Results: Thirteen percent (n=53,092) of patients with HFrEF have concurrent ADRD. The average patient with HF+ADRD is 4 years older than the average non-ADRD HF patient and rates of hypertension, diabetes, renal failure, lung disease, vascular disease and frailty are all higher among HF+ADRD patients (p<0.001; Table 1 ). Differences in 30-day and 1-year readmission rates are statistically significant, but relatively small. (30-day: 23% vs. 25%; 1-year: 64% vs. 66% ,p<0.001). However, 30-day and 1-year mortality rates are markedly higher for HF+ADRD patients (30-day: 5% vs. 10%; 1-year: 30% vs. 49%). Conclusions: Thirteen percent of HFrEF patients have concurrent ADRD. On average, this population is older, frailer and has more comorbidities than HFrEF patients without ADRD. While readmission rates are similar, HF+ADRD patients have markedly higher short and long-term mortality. Additional work is needed to understand how much of this increased mortality can be prevented with improved HFrEF care.
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