Abstract TP324: Mild Cognitive Impairment and Treatment for Ischemic Stroke and Acute Myocardial Infarction

Abstract

Background and Objectives: Cardiovascular disease (CVD) is the leading cause of death and serious morbidity in older adults with mild cognitive impairment (MCI), many of whom will not progress to dementia. It is unclear whether patients with pre-existing MCI (without dementia) get evidence-based treatments for CVD less often than patients without MCI. We compared treatment for acute ischemic stroke and acute myocardial infarction (AMI) between MCI patients and cognitively normal patients in a nationally representative sample. Methods: Prospective study of patients aged ≥65 years hospitalized with ischemic stroke (n=517) or AMI (n=509) from the Health and Retirement Study and Medicare data from 2000-2011. We compared receipt of CVD process measures (Table) within 12 months of the stroke or AMI hospitalization from Medicare claims between subjects with pre-existing MCI (modified Telephone Interview for Cognitive Status [TICS-m] score, 7-11, a valid measure of MCI) and those with normal cognition (TICS-m score, 12-27), and used logistic regression to adjust associations for age, sex, race, education, number of preexisting functional limitations, and comorbidity. Results: Compared with cognitively normal patients, patients with pre-existing MCI were significantly less likely to receive all 3 AMI process measures, and they got stroke process measures less frequently but results were not statistically significant (Table). MCI patients were less likely than cognitively normal patients to receive any post-MI revascularization (adjusted odds ratio, 0.54; 95% CI, 0.33-0.88), but not the other CVD process measures, after adjustment (Table). Conclusion: Older MCI patients less frequently got process measures for AMI and ischemic stroke compared with cognitively normal patients. Patient factors explain some but not all of this reduced use. We need to better understand decision making for CVD treatment in older MCI patients and reasons for treatment differences.