患有痴呆症的medicare受益者在急诊科STEMI就诊后的居家存活天数

摘要(中文译文)

※ 中文译文由 AI 辅助生成,仅供学术参考,请以英文原文为准。

随着患有阿尔茨海默病及相关痴呆症（ADRD）的老年人口不断增加，越来越多的人出现急性心血管事件，包括ST段抬高型心肌梗死（STEMI）。该人群接受STEMI治疗后的以患者为中心的结局尚不充分了解。这项回顾性队列研究使用来自全国100%样本的Medicare按服务收费索赔数据，识别2017年至2022年间因STEMI就诊于急诊科（ED）并接受心导管检查的65岁及以上受益人。患者按ADRD状态和养老院入院来源进行分层。主要结局为索引急诊就诊后一年内调整后的居家存活天数。次要结局包括1年生存率、居家存活天数百分比以及长期养老院护理使用（≥100天）。多变量线性回归模型控制了年龄、性别和合并症。在117,318名患者中，7348名（6.3%）患有ADRD，2617名（2.2%）来自养老院入院。在社区居住患者中，患有ADRD者的调整后居家天数略低于无ADRD者（225.1天 vs. 299.4天；调整后差异为-37.8天；95% CI，-41.1至-34.5），但超过一半的人居家时间超过300天。在从养老院入院的患者中，ADRD与显著更差的结局相关（调整后差异为-71.9天；95% CI，-84.0至-59.8），1年生存率为42.4%。许多患有ADRD的社区居住老年人在因STEMI接受心导管检查后获得了有意义的生存和居家时间。仅凭痴呆状态不应阻碍适当的STEMI治疗。治疗决策应基于认知状态、入院来源和患者目标进行个体化制定。

Abstract

As the population of older adults with Alzheimer's disease and related dementias (ADRD) increases, a growing number are presenting with acute cardiovascular events, including ST-elevation myocardial infarction (STEMI). Patient-centered outcomes following treatment for STEMI in this population are not well understood. This retrospective cohort study used Medicare fee-for-service claims from a 100% national sample to identify beneficiaries aged 65 years or older who presented to the emergency department (ED) with STEMI between 2017 and 2022 and underwent cardiac catheterization. Patients were stratified by ADRD status and nursing home admission source. The primary outcome was adjusted days alive at home in the year following the index ED visit. Secondary outcomes included 1-year survival, percent of alive days spent at home, and long-term nursing home care use (≥ 100 days). Multivariable linear regression models controlled for age, sex, and comorbidities. Of 117,318 patients, 7348 (6.3%) had ADRD and 2617 (2.2%) were admitted from a nursing home. Among community-dwelling patients, those with ADRD had moderately lower adjusted days at home than those without ADRD (225.1 vs. 299.4; adjusted difference -37.8 days; 95% CI, -41.1 to -34.5), but more than half spent over 300 days at home. Among patients admitted from a nursing home, ADRD was associated with markedly worse outcomes (adjusted difference -71.9 days; 95% CI, -84.0 to -59.8), and 1-year survival was 42.4%. Many community-dwelling older adults with ADRD experienced meaningful survival and time at home following cardiac catheterization for STEMI. Dementia status alone should not deter appropriate STEMI care. Treatment decisions should be individualized based on cognitive status, admission source, and patient goals.

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