Anish Sethi1, George Albert2, Daryl McHugh2, Benjamin George2
1Drexel University College of Medicine, 2University of Rochester Medical Center, Department of Neurology
Objective:
To determine differences in acute stroke therapies and outcomes between acute ischemic stroke patients with and without pre-existing dementia.
Background:
Strokes are debilitating, recovery may be challenging for patients with pre-existing dementia. Given the rise in availability in acute stroke therapies concurrent with an aging US population, it is important to elucidate access to interventions and outcomes associated with dementia in the inpatient setting.
Design/Methods:
We conducted a retrospective observational study using State Inpatient Database hospitalization data for California, Florida, and New York, 2018-2020. Acute ischemic stroke was identified using International Classification of Disease, 10th edition billing codes. Coarsened exact matching was used to pair stroke patients with and without pre-existing dementia matched by age. Logistic regression controlling for demographics and comorbidities was used to assess differences in thrombolysis, endovascular thrombectomy (EVT), mechanical ventilation, gastrostomy, and total mortality equivalence (defined as death or hospice discharge).
Results:
There were 36,978 patients with pre-existing dementia hospitalized for acute stroke one-to-one matched on age to stroke hospitalizations without dementia. Patients with dementia were less likely to receive thrombolysis (aOR [adjusted odds ratio] = 0.77, 99% CI 0.67-0.88), EVT (aOR = 0.49, 99% CI 0.43-0.54), and mechanical ventilation (aOR = 0.82, 99% CI 0.78-0.87). Conversely, gastrostomy placement was more likely for patients with pre-existing dementia (aOR = 1.26, 99% CI [1.14-1.39]). Patients with dementia were less likely to die in the hospital (aOR = 0.90, 99% CI [0.84-0.96]), however, had greater odds of mortality when accounting for inpatient death or hospice discharge (aOR = 1.52, 99% CI 1.40-1.65).
Conclusions:
Hospitalized patients with acute stroke and pre-existing dementia are less likely to receive interventions for acute stroke and face increased risk of mortality. Hospice discharge is important to consider when assessing total mortality for inpatients with stroke and pre-existing dementia.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.