Abstract
Background and purpose
Older patients with pre-existing mild cognitive impairment (MCI) receive less evidence-based
care after acute myocardial infarction, however, whether they receive less care after
acute ischemic stroke (AIS) is unknown. We compared receipt of guideline-concordant
procedures after AIS between older adults with pre-existing MCI and normal cognition.
Methods
Prospective study of 591 adults ≥65 hospitalized for AIS between 2000 and 2014, and
followed through 2015 using data from the nationally representative Health and Retirement
Study, Medicare and American Hospital Association. We assessed pre-existing MCI (modified
Telephone Interview for Cognitive Status score of 7–11) and normal cognition (score
of 12–27). Primary outcome was a composite quality measure representing the number
of 4 procedures (carotid imaging, cardiac monitoring, echocardiogram, and rehabilitation
assessment) received within 30 days after AIS (ordinal scale with values of 0, 1,
2, 3–4).
Results
Among survivors of AIS, 26.9% had pre-existing MCI (62.9% were women, with a mean
[SD] age of 82.4 [7.7] years), and 73.1% had normal cognition (51.4% were women, with
a mean age of 78.4 [7.2] years). Patients with pre-existing MCI, compared to cognitively
normal patients, had 39% lower cumulative odds of receiving the composite quality
measure (unadjusted cumulative odds ratio, OR, 0.61 [95% CI, 0.43–0.87]; P=0.006). However, this association became non-significant after adjusting for patient
and hospital factors (adjusted cumulative OR, 0.83 [95% CI, 0.56–1.24]; P=0.37). Lower cumulative odds of receiving the composite quality measure were associated
with older patient age (adjusted cumulative OR per 1-year older age, 0.97 [95% CI,
0.95–0.99]; P=0.01) and Southern hospitals (adjusted cumulative OR for South vs North, 0.54 [95%
CI, 0.31–0.94]; P=0.03).
Conclusions
Differences in receipt of guideline-concordant procedures after AIS exist between
patients with pre-existing MCI and normal cognition. These differences were largely
explained by patient and regional factors associated with receiving less AIS care.
Keywords
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Article info
Publication history
Published online: August 12, 2020
Accepted:
June 21,
2020
Received:
May 19,
2020
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105083
Copyright
© 2020 Elsevier Inc. All rights reserved.
