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Perspectives on Why Patients with Mild Cognitive Impairment Might Receive Fewer Cardiovascular Disease Treatments than Patients with Normal Cognition

Authors :
Emilie M. Blair
Bailey K. Reale
Darin B. Zahuranec
Jane Forman
Kenneth M. Langa
Bruno Giordani
Angela Fagerlin
Colleen Kollman
Rachael T. Whitney
Deborah A. Levine
Source :
Journal of Alzheimer's Disease. 91:573-584
Publication Year :
2023
Publisher :
IOS Press, 2023.

Abstract

Background: People with mild cognitive impairment (MCI) receive fewer guideline-concordant treatments for cardiovascular disease (CVD) than people with normal cognition (NC). Objective: To understand physician perspectives on why patients with MCI receive fewer CVD treatments than patients with NC. Methods: As part of a mixed-methods study assessing how patient MCI influences physicians’ decision making for acute myocardial infarction (AMI) and stroke treatments, we conducted a qualitative study using interviews of physicians. Topics included participants’ reactions to data that physicians recommend fewer CVD treatments to patients with MCI and reasons why participants think fewer CVD treatments may be recommended to this patient population. Results: Participants included 22 physicians (8 cardiologists, 7 neurologists, and 7 primary care physicians). Most found undertreatment of CVD in patients with MCI unreasonable, while some participants thought it could be considered reasonable. Participants postulated that other physicians might hold beliefs that could be reasons for undertreating CVD in patients with MCI. These beliefs fell into four main categories: 1) patients with MCI have worse prognoses than NC, 2) patients with MCI are at higher risk of treatment complications, 3) patients’ cognitive impairment might hinder their ability to consent or adhere to treatment, and 4) patients with MCI benefit less from treatments than NC. Conclusion: These findings suggest that most physicians do not think it is reasonable to recommend less CVD treatment to patients with MCI than to patients with NC. Improving physician understanding of MCI might help diminish disparities in CVD treatment among patients with MCI.

Details

ISSN :
18758908 and 13872877
Volume :
91
Database :
OpenAIRE
Journal :
Journal of Alzheimer's Disease
Accession number :
edsair.doi.dedup.....8ba5eba1569a6690d460ec5aa0132b70
Full Text :
https://doi.org/10.3233/jad-220495