Journal of the American Geriatrics Society· 2026Q1
Days Alive at Home After Emergency Department STEMI Visits Among Medicare Beneficiaries With Dementia
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- Q1SCImago
- 2026year
Short summary
Medicare beneficiaries with dementia who presented to the ED with STEMI and underwent cardiac catheterization spent 37.8 fewer days at home in the year following the visit compared to those without dementia (225.1 vs. 299.4 days).
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Key points
- Patients with dementia had 37.8 fewer days alive at home in the year after a STEMI ED visit compared to those without dementia (225.1 vs. 299.4 days).
- Over half of community-dwelling patients with dementia still spent more than 300 days at home post-STEMI.
- STEMI patients admitted from a nursing home with dementia experienced significantly worse outcomes, with an adjusted difference of -71.9 days at home and 42.4% 1-year survival.
- Dementia status should not deter appropriate STEMI care; decisions should be individualized.
AI-generated from the title and abstract; the full text is not read.
Abstract
ABSTRACT Background 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. Methods 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. Results 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%. Conclusion 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.
The authors' abstract, as published at the source. Journal of the American Geriatrics Society, 2026 · DOI ↗
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Field: Critical Care and Intensive Care Medicine
Critical Care and Intensive Care MedicineMedicine