Heart Attack Patients with Mild Cognitive Impairment Less Likely to Receive Treatments

Those with mild cognitive impairment (MCI) may be less likely to receive certain heart treatments than their healthy counterparts, a new study shows. MCI falls between normal brain function and dementia in the realm of cognitive decline and does not indicate that a patient would receive less benefit from proven treatments than their cognitively normal peers. Some invasive procedures are not indicated for those with advanced dementia or short life expectancy, but lead author Deborah Levine, M.D., MPH, claims that MCI does not have such indications. This work was published in the Journal of General Internal Medicine.

“Patients should get the treatments they would want if they were properly informed,” said Levine, an associate professor of internal medicine and neurology at the University of Michigan’s academic medical center, Michigan Medicine.

Unlike Alzheimer’s disease and other forms of dementia, MCI does not severely interfere with daily activities and may not exacerbate over time. Although MCI patients express cognitive, memory, and language issues and are at an increased risk of developing dementia, Levine says they are not necessarily fated to eventually develop the condition.

“While some may progress to dementia, many will persist in having MCI, and a few will actually improve and revert to normal cognition,” she explained. “Many older adults with MCI live years with good quality of life, and so face common health risks of aging like heart attack and stroke. Clinicians, patients, and families might be overestimating the risk of dementia after a mild cognitive impairment diagnosis even without realizing it. These older adults with MCI should still receive evidence-based treatments when indicated.” Levine is also a member of the University of Michigan Institute for Healthcare Policy and Innovation.

Background of the MCI Study

Levine and colleagues analyzed data from 609 adults aged 65 years or older who had been hospitalized for a heart attack between 2000 and 2011. This data was collected from the Health and Retirement Study, a University of Michigan-based longitudinal study of elderly Americans.

The team found that pre-existing MCI was correlated with a significantly lower rate of guideline-consistent medical interventions, including catheter-based and open-heart surgery, in these elderly heart attack patients. Cardiac catheterization and coronary revascularization were 35% and 45% less likely to be performed in patients with pre-existing MCI.

Levine added that both procedures have shown high efficacy in reducing death and improving physical function after a heart attack in various clinical trials. This is a concerning discrepancy, being that many older patients at risk for MCI are also at high risk for cardiovascular disease.

“This is a timely issue because as the population ages, the number of seniors 85 years old and older has become the fastest-growing segment of the U.S. population,” explained Levine. “Seniors 85 and older are most likely to have MCI, and their incidence of heart attack has surged.”

Levine adds that the number of elderly patients with MCI is likely to rise as well, being that the Affordable Care Act included the coverage of impairment assessments for those with Medicare. Her team’s findings suggest that physicians may not be recommending invasive treatments to MCI patients as much as they would in patients with normal cognitive functioning. Levine urges physicians to reflect on the influence of the patient’s MCI in their decision-making following a heart attack.

“Studies like this are an important first step in raising awareness on MCI so that providers, like cardiologists, can make sure they offer the best therapies available during heart attacks,” noted senior author Brahmajee Nallamothu, M.D., MPH, an interventional cardiologist and professor of internal medicine at Michigan Medicine.