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Readmission and adverse outcomes after percutaneous coronary intervention in patients with dementia.

Publication ,  Journal Article
Park, DY; Hu, J-R; Alexander, KP; Nanna, MG
Published in: J Am Geriatr Soc
April 2023

BACKGROUND: As the population ages, clinicians increasingly encounter ischemic heart disease in patients with underlying dementia. Therefore, we quantified differences in inhospital adverse events and 30-day readmission rates among patients with and without dementia undergoing percutaneous coronary intervention (PCI). METHODS: Using the National Readmissions Database 2017-2018, we identified 755,406 index hospitalizations in which PCI was performed, of which 17,309 (2.3%) had a diagnosis of dementia. After propensity score matching patients with and without dementia, we assessed 30-day readmission and inhospital adverse events by Cox proportional hazards and logistic regression modeling and compared them with those of other common cardiac (pacemaker placement [PP]) and noncardiac (hip replacement surgery [HRS]) procedures. RESULTS: Thirty-day readmission was significantly higher in patients with dementia than patients without dementia (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.60-1.74). Patients with dementia also experienced higher odds of delirium (odds ratio [OR] 4.37, CI 3.69-5.16), inhospital mortality (OR 1.15, CI 1.01-1.30), cardiac arrest (OR 1.19, CI 1.01-1.39), acute kidney injury (OR 1.30, CI 1.21-1.39), and fall (OR 2.51, CI 2.06-3.07). On multivariable Cox modeling, dementia independently predicted 30-day readmission (HR 1.14, CI 1.07-1.20). The higher readmission risk with PCI (11%) among those with dementia was similar to that of patients undergoing PP (10%), but lower than in those undergoing HRS (41%). CONCLUSION: Patients with dementia who undergo PCI experience significantly increased rates of inhospital delirium, mortality, kidney injury, falls, and 30-day readmission. These adverse outcomes should be considered during shared decision-making with patients and their families.

Duke Scholars

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Published In

J Am Geriatr Soc

DOI

EISSN

1532-5415

Publication Date

April 2023

Volume

71

Issue

4

Start / End Page

1034 / 1046

Location

United States

Related Subject Headings

  • Percutaneous Coronary Intervention
  • Patient Readmission
  • Myocardial Ischemia
  • Humans
  • Geriatrics
  • Dementia
  • Delirium
  • 52 Psychology
  • 42 Health sciences
  • 32 Biomedical and clinical sciences
 

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Park, D. Y., Hu, J.-R., Alexander, K. P., & Nanna, M. G. (2023). Readmission and adverse outcomes after percutaneous coronary intervention in patients with dementia. J Am Geriatr Soc, 71(4), 1034–1046. https://doi.org/10.1111/jgs.18120
Park, Dae Yong, Jiun-Ruey Hu, Karen P. Alexander, and Michael G. Nanna. “Readmission and adverse outcomes after percutaneous coronary intervention in patients with dementia.J Am Geriatr Soc 71, no. 4 (April 2023): 1034–46. https://doi.org/10.1111/jgs.18120.
Park DY, Hu J-R, Alexander KP, Nanna MG. Readmission and adverse outcomes after percutaneous coronary intervention in patients with dementia. J Am Geriatr Soc. 2023 Apr;71(4):1034–46.
Park, Dae Yong, et al. “Readmission and adverse outcomes after percutaneous coronary intervention in patients with dementia.J Am Geriatr Soc, vol. 71, no. 4, Apr. 2023, pp. 1034–46. Pubmed, doi:10.1111/jgs.18120.
Park DY, Hu J-R, Alexander KP, Nanna MG. Readmission and adverse outcomes after percutaneous coronary intervention in patients with dementia. J Am Geriatr Soc. 2023 Apr;71(4):1034–1046.
Journal cover image

Published In

J Am Geriatr Soc

DOI

EISSN

1532-5415

Publication Date

April 2023

Volume

71

Issue

4

Start / End Page

1034 / 1046

Location

United States

Related Subject Headings

  • Percutaneous Coronary Intervention
  • Patient Readmission
  • Myocardial Ischemia
  • Humans
  • Geriatrics
  • Dementia
  • Delirium
  • 52 Psychology
  • 42 Health sciences
  • 32 Biomedical and clinical sciences