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

Article type: Research Article

Authors: Blair, Emilie M.^a | Reale, Bailey K.^{a; b} | Zahuranec, Darin B.^c | Forman, Jane^{a; d} | Langa, Kenneth M.^{a; d; e; f} | Giordani, Bruno^g | Fagerlin, Angela^h | Kollman, Colleenⁱ | Whitney, Rachael T.^a | Levine, Deborah A.^{a; b; e; *}

Affiliations: [a] Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan (U-M), Ann Arbor, MI, USA | [b] Lake Erie College of Osteopathic Medicine, Greensburg, PA, USA | [c] Department of Neurology and Stroke Program, U-M, Ann Arbor, MI, USA | [d] VA Ann Arbor Healthcare System, Ann Arbor, MI, USA | [e] Institute for Healthcare Policy and Innovation, U-M, Ann Arbor, MI, USA | [f] Institute for Social Research, U-M, Ann Arbor, MI, USA | [g] Department of Psychiatry & Michigan Alzheimer’s Disease Center, U-M, Ann Arbor, MI, USA | [h] Department of Population Health Sciences, UT and Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS 2.0) Center for Innovation, University of Utah, Salt Lake City, UT | [i] Kollman Research Services, Ann Arbor, MI, USA

Correspondence: [*] Correspondence to: Deborah A. Levine, MD, MPH, University of Michigan Division of General Medicine, North Campus Research Complex, 2800 Plymouth Rd, B16-F4, Ann Arbor, MI 48109-2800, USA. Tel.: +1 734 936 5216; E-mail: deblevin@umich.edu.

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.

Keywords: Aging, cognition, treatment disparities

DOI: 10.3233/JAD-220495

Journal: Journal of Alzheimer's Disease, vol. 91, no. 2, pp. 573-584, 2023