Article Impact Level: HIGH Data Quality: STRONG Summary of Clinical Cardiology, 46(10), 1253–1259. https://doi.org/10.1002/clc.24091 Dr. Wonjae Lee et al.
Points
- Rising dementia rates in South Korea pose a concern, particularly when coupled with acute myocardial infarction (AMI).
- A retrospective cohort study examined 16,835 AMI patients, of whom 2021 also had dementia, using data from the National Health Insurance Service-Senior.
- Patients with both AMI and dementia exhibited significantly higher all-cause mortality risk compared to those without dementia.
- Medication possession ratio (MPR) analysis revealed poorer medication adherence among AMI patients with dementia, particularly concerning aspirin.
- Multivariable analysis identified dementia and poor medication adherence as significant predictors of all-cause mortality in AMI patients, emphasizing the need for targeted interventions to improve outcomes in this population.
Summary
In South Korea, the prevalence of dementia is on the rise, presenting a concerning trend alongside acute myocardial infarction (AMI), a condition associated with high mortality rates. This study aims to investigate the impact of dementia and medication compliance on the mortality of AMI patients. Utilizing data from the National Health Insurance Service-Senior, a retrospective cohort study was conducted involving 16,835 patients diagnosed with AMI between 2007 and 2013, among whom 2021 also had dementia. Medication possession ratio (MPR) was employed to evaluate medication adherence.
AMI patients with dementia exhibited unfavorable baseline characteristics and were found to have a significantly elevated risk of all-cause mortality compared to those without dementia (hazard ratio [HR]: 2.49; 95% confidence interval [CI]: 2.34−2.66; p < .001). Furthermore, patients with dementia demonstrated lower MPR rates, particularly in aspirin adherence (21.9% vs. 42.8%; p < .001). Stratification of AMI patients based on dementia presence and medication adherence revealed varying survival rates, with the highest survival observed in those without dementia with good adherence, followed by those without dementia with poor adherence, those with dementia with good adherence, and finally, those with dementia with poor adherence. Multivariable analysis affirmed dementia (HR: 1.64; 95% CI: 1.53−1.75; p < .001) and poor medication adherence (HR: 1.60; 95% CI: 1.49−1.71; p < .001) as significant predictors of all-cause mortality in AMI patients.
In conclusion, AMI patients with dementia experience a heightened risk of mortality, exacerbated by suboptimal medication adherence compared to patients without dementia. These findings underscore the importance of tailored interventions to improve medication compliance and clinical outcomes in this vulnerable population.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/clc.24091
References Lee, W., Kang, S., Kim, S., Lee, S., Myung, W., Jheon, K., Yoon, C., Suh, J., Youn, T., & Chae, I. (2023). Impact of dementia and drug compliance on patients with acute myocardial infarction. Clinical Cardiology, 46(10), 1253–1259. https://doi.org/10.1002/clc.24091
