Age, Dementia and Care Patterns after Admission for Acute Coronary Syndrome An Analysis from a Nationwide Cohort under the National Health Insurance Coverage

Abstract

Background The number of elderly and the prevalence of dementia have grown considerably in recent years. Little is known about how aging and dementia affect care patterns after discharge for acute coronary syndrome (ACS). Objective This study was designed to assess the impact of dementia on care patterns after admission for patients with ACS across different age groups. Methods Of 87,321 patients hospitalized for ACS between 1 January 2006 and 31 December 2007, 1,835 patients with dementia and 3,670 matched patients without dementia (1:2 ratio, matched by age, sex and hospital level) were identified from Taiwan's National Health Insurance Research Database. Use of interventional therapies at hospitalization and guideline-recommended medications post-discharge were compared between patients with and without dementia across different age groups (<= 65, 66-75, 76-85, >= 86 years). Multivariate logistic regression models were performed to examine the impact of dementia on care patterns. Results Overall, dementia was associated with a 27 % lower likelihood of receipt of interventional therapies [adjusted odds ratio (OR) = 0.73; 95 % CI 0.63, 0.83] and a 22 % lower likelihood of guideline-recommended medications (adjusted OR = 0.78; 95 % CI 0.68, 0.89) in ACS patients. The use of interventional therapies and guideline-recommended medications decreased with age, and interactions between age and dementia were found. The proportions of patients receiving interventional therapies were 39.4 % (without dementia) versus 21.8 % (with dementia) in the youngest age group and 18.6 % (without dementia) versus 14.5 % (with dementia) in the oldest age group. Patients with dementia (age <= 65 years 73.6 %; age 66-75 years 82.3 %; age 76-85 years 71.8 %; age >= 86 years 55.6 %) were less likely to receive guideline-recommended medications as compared with those without dementia (age <= 65 years 85.6 %; age 66-75 years 87.5 %; age 76-85 years 81.2 %; age >= 86 years 62.0 %). Conclusion Dementia and aging were associated with decreased use of interventional therapies and guideline-recommended medications in ACS patients.