Study Shows Higher Rates of Incident Pacemakers in Dementia Patients

It has been shown that mild cognitive impairment (MCI) and dementia in older adults causes cardiac comorbidities, qualifying them for electronic cardiac device-based therapy. An epidemiologic study, published July 28 in JAMA Internal Medicine, revealed that the use of cardiac implantable devices is higher in older adults with MCI than those without MCI.

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The retrospective cohort study, with data taken from the National Alzheimer Coordinating Uniform Data Set, assessed 16,245 participants who had one baseline visit at an Alzheimer Disease Center and at least one follow-up visit. The study, led by Nicole R. Fowler, PhD, MHSA, recorded the rate of occurrence of pacemakers in the participants during the seven year period. The participants ranged in diagnosis from no cognitive impairment (7446 participants) to those with dementia (5339 participants), while those with MCI were numbered at 3460. On average, those with cognitive impairment were older (mean age: 74) and male, with a majority of participants showing comparable rates of atrial fibrillation and congestive heart failure.

Each analysis of incident device was adjusted for age, sex, race and the intensity of pacemaker use. During the seven years of the study, the investigators found that compared to patients without cognitive impairment, those with dementia prior to their assessment were 1.6 times more likely to receive a pacemaker, participants with stable dementia were 1.8 times more likely, and those with severe dementia (a Clinical Dementia Rating of 3) were 2.9 times more likely.

The results of the study show that, despite having a life-limiting illness, patients with dementia or other MCI receive aggressive cardiac treatment more often than those without cognitive impairments. According to the authors, "it is possible that unmeasured confounding by indication explains this observation, [but] future research should explore the patient, caregiver and clinician influences on decision making regarding cardiac devices in this population."

Keywords: Follow-Up Studies, Decision Making, Dementia, Heart Failure, Comorbidity, Cognition Disorders, Caregivers

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