Heart attack patients with mild cognitive problems get fewer treatments

In a new study, researchers found people who have mild cognitive impairment (MCI) are less likely to receive proven heart attack treatment in the hospital.

But there is no evidence that those with MCI would derive less benefit from evidence-based treatment that’s offered to their cognitively normal peers who have heart attacks.

The research was conducted by a team from Michigan Medicine.

MCI lies on the continuum of cognitive decline between normal cognition and dementia.

Some people with thinking, memory and language problems have MCI.

Unlike dementia, which severely interferes with daily functioning and worsens over time, MCI does not severely interfere with daily functioning and might not worsen over time.

Although people with MCI have an increased risk of developing dementia, it’s not an inevitable next step.

Many older adults with MCI live years with a good quality of life, and so face common health risks of aging like heart attack and stroke.

Clinicians, patients, and families might be overestimating the risk of dementia after an MCI diagnosis even without realizing it.

These older adults with MCI should still receive evidence-based treatments when indicated.

In the study, the team measured 609 adults ages 65 and older who were hospitalized for a heart attack between 2000 and 2011.

They found pre-existing MCI was associated with significantly lower use of guideline-concordant care after a heart attack, whether catheter-based or open surgery.

The team notes both cardiac catheterization (35% less likely in patients with pre-existing MCI) and coronary revascularization (45% less likely in patients with pre-existing MCI) have been shown to be highly effective at reducing deaths and improving physical functioning after a heart attack in multiple large clinical trials.

They say physicians might not be recommending invasive treatments as often after an older patient with some memory and thinking problems has a heart attack.

They encourage clinicians to reflect on the influence of MCI in their decision-making.

Up to 1 in 5 adults aged 65 and older have MCI, although many may be undiagnosed. Since the Affordable Care Act mandated coverage of cognitive impairment assessments for Medicare beneficiaries, MCI diagnoses are expected to increase.

The lead author of the study is Deborah Levine, M.D., MPH.

The study is published in Journal of General Internal Medicine.

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