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.

中文翻译：

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轻度认知障碍和接受老年人急性缺血性中风手术。

背景和目的

已有轻度认知障碍 (MCI) 的老年患者在急性心肌梗死后接受的循证护理较少，然而，他们在急性缺血性中风 (AIS) 后是否接受较少的护理尚不清楚。我们比较了患有预先存在 MCI 的老年人和正常认知的老年人在 AIS 后接受指南一致的程序。

方法

对 2000 年至 2014 年期间因 AIS 住院的 591 名 65 岁以上成人进行前瞻性研究，并使用来自全国代表性的健康和退休研究、医疗保险和美国医院协会的数据进行跟踪到 2015 年。我们评估了预先存在的 MCI（认知状态的修改电话访谈评分为 7-11）和正常认知（评分为 12-27）。主要结果是综合质量测量，代表 AIS 后 30 天内接受的 4 个程序（颈动脉成像、心脏监测、超声心动图和康复评估）的数量（顺序量表，值为 0、1、2、3-4）。

结果

在 AIS 幸存者中，26.9% 有预先存在的 MCI（62.9% 为女性，平均 [SD] 年龄为 82.4 [7.7] 岁），73.1% 认知正常（51.4% 为女性，平均年龄为78.4 [7.2] 年）。与认知正常的患者相比，预先存在 MCI 的患者接受复合质量测量的累积几率低 39%（未调整的累积几率比，OR，0.61 [95% CI，0.43–0.87]；P = 0.006）。然而，在调整患者和医院因素后，这种关联变得不显着（调整后的累积 OR，0.83 [95% CI，0.56–1.24]；P = 0.37）。接受复合质量测量的较低累积几率与年龄较大的患者相关（调整后每 1 岁的累积 OR，0.97 [95% CI，0.95–0.99]；P=0.01) 和南方医院（调整南方与北方的累积 OR，0.54 [95% CI，0.31–0.94]；P=0.03）。

结论

预先存在 MCI 和正常认知的患者在 AIS 后接受指南一致的程序存在差异。这些差异在很大程度上是由与接受较少 AIS 护理相关的患者和区域因素解释的。