Abstract TP566: Reasons Pre-Existing Mild Cognitive Impairment May Influence Physician Recommendations for Stroke and Heart Attack Treatments

Abstract

Background: Mild cognitive impairment (MCI) is common, affecting up to 1 in 5 adults 65 or older. Although it is known that physicians recommend fewer treatments for stroke and acute myocardial infarction (AMI) to patients with pre-existing dementia, it is unknown how pre-existing MCI influences physician recommendations for stroke and AMI treatments. Methods: Qualitative study based on in-depth, semi-structured, in-person interviews with physicians from 2 academic medical centers. We interviewed neurologists (n=7), primary care physicians (n=7), and cardiologists (n=7) using a standard guide. Qualitative content analysis was used to identify unifying and recurrent themes. Participants were asked to reflect on data from a pilot study suggesting that physicians recommended fewer treatments for stroke and AMI to older adults with MCI. Responses between specialties were compared. Results: Participants postulated reasons that fewer stroke and AMI treatments were recommended to MCI patients (Table 1). The most common reasons were that physicians may assume patients with MCI have a poor prognosis, quality of life, or will soon progress to dementia (71%), that treatments are risky or harmful (67%), and that patients with MCI won’t comply with treatment (52%). Neurologists more frequently assumed that patients with MCI benefit less from stroke treatments. Whereas, cardiologists often thought that patients with MCI face greater risks from AMI treatments. All three specialties felt that physicians made assumptions that patients with MCI are not able to comply with treatment. Conclusion: Physicians may think that patients with MCI are more likely to have a poor prognosis, benefit less from treatments, and/or face greater risks from treatments than cognitively normal patients. Such beliefs may lead physicians to recommend fewer treatments for stroke and AMI to patients with MCI.