Baseline Dementia Prevalence and Subtypes in Older Adults Hospitalized With Acute Coronary Syndrome: A Multicenter Study From a Large Integrated Health Care Delivery System.

BACKGROUND

Dementia is increasingly common among older adults (≥ 65 years) and is associated with poor outcomes. However, little is known about its baseline prevalence in patients hospitalized with acute coronary syndrome (ACS), particularly across revascularization strategies.

METHODS

The authors conducted a cross-sectional analysis from a current longitudinal cohort study of Kaiser Permanente Northern California members hospitalized with ACS between January 2010 and December 2020. Dementia diagnoses and subtypes were identified using International Classification of Diseases 9/10 codes. Baseline prevalence was compared across revascularization strategies: percutaneous coronary intervention, coronary artery bypass grafting, or no revascularization.

RESULTS

Among 26,749 patients with ACS, the mean age was 76.7 ± 8.0 years; patients not revascularized were older than those who were (77.7 ± 8.3 vs 74.9 ± 7.0 years; P < .001). Overall, 57.4% were male, with a higher proportion among revascularized patients. The overall baseline prevalence of dementia was 5.9%, substantially lower among revascularized (1.9%) vs nonrevascularized patients (7.9%; P < .001). Dementia prevalence was 2.0% for percutaneous coronary intervention, 0.6% for coronary artery bypass grafting, and 7.9% for no revascularization. Alzheimer's disease was the most common subtype (85.7%), followed by vascular (5.7%), Lewy body/Parkinson's (3.7%), frontotemporal (1.0%), and unspecified types (3.9%).

CONCLUSION

One in 17 older adults hospitalized with ACS had a documented diagnosis of dementia at baseline, with substantial variation by revascularization strategy. These findings highlight the baseline burden of dementia in this high-risk population and support the need for future research on the incidence and progression of cognitive impairment after ACS.