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Mild cognitive impairment and receipt of procedures for acute ischemic stroke in older adults

  • Deborah A. Levine
    Correspondence
    Corresponding author.
    Affiliations
    Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, NCRC 16-430W, 2800 Plymouth Road, Ann Arbor, MI 48109-2800, United States

    Department of Neurology and Stroke Program, University of Michigan, Ann Arbor, MI, United States

    Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
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  • Andrzej Galecki
    Affiliations
    Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, NCRC 16-430W, 2800 Plymouth Road, Ann Arbor, MI 48109-2800, United States

    Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States
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  • Mohammed Kabeto
    Affiliations
    Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, NCRC 16-430W, 2800 Plymouth Road, Ann Arbor, MI 48109-2800, United States
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  • Brahmajee K. Nallamothu
    Affiliations
    Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, NCRC 16-430W, 2800 Plymouth Road, Ann Arbor, MI 48109-2800, United States

    Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States

    VA Ann Arbor Healthcare System, University of Michigan, Ann Arbor, MI, United States
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  • Darin B. Zahuranec
    Affiliations
    Department of Neurology and Stroke Program, University of Michigan, Ann Arbor, MI, United States
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  • Lewis B. Morgenstern
    Affiliations
    Department of Neurology and Stroke Program, University of Michigan, Ann Arbor, MI, United States

    Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States

    Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
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  • Lynda D. Lisabeth
    Affiliations
    Department of Neurology and Stroke Program, University of Michigan, Ann Arbor, MI, United States

    Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
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  • Bruno Giordani
    Affiliations
    Department of Psychiatry and Michigan Alzheimer's Disease Center, University of Michigan, Ann Arbor, MI, United States
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  • Kenneth M. Langa
    Affiliations
    Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, NCRC 16-430W, 2800 Plymouth Road, Ann Arbor, MI 48109-2800, United States

    Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States

    VA Ann Arbor Healthcare System, University of Michigan, Ann Arbor, MI, United States

    Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
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      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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