Days Alive at Home After Emergency Department STEMI Visits Among Medicare Beneficiaries With Dementia

ABSTRACT Background As the population of older adults with Alzheimer's disease and related dementias (ADRD) increases, a growing number are presenting with acute cardiovascular events, including ST‐elevation myocardial infarction (STEMI). Patient‐centered outcomes following treatment for STEMI in this population are not well understood. Methods This retrospective cohort study used Medicare fee‐for‐service claims from a 100% national sample to identify beneficiaries aged 65 years or older who presented to the emergency department (ED) with STEMI between 2017 and 2022 and underwent cardiac catheterization. Patients were stratified by ADRD status and nursing home admission source. The primary outcome was adjusted days alive at home in the year following the index ED visit. Secondary outcomes included 1‐year survival, percent of alive days spent at home, and long‐term nursing home care use (≥ 100 days). Multivariable linear regression models controlled for age, sex, and comorbidities. Results Of 117,318 patients, 7348 (6.3%) had ADRD and 2617 (2.2%) were admitted from a nursing home. Among community‐dwelling patients, those with ADRD had moderately lower adjusted days at home than those without ADRD (225.1 vs. 299.4; adjusted difference −37.8 days; 95% CI, −41.1 to −34.5), but more than half spent over 300 days at home. Among patients admitted from a nursing home, ADRD was associated with markedly worse outcomes (adjusted difference −71.9 days; 95% CI, −84.0 to −59.8), and 1‐year survival was 42.4%. Conclusion Many community‐dwelling older adults with ADRD experienced meaningful survival and time at home following cardiac catheterization for STEMI. Dementia status alone should not deter appropriate STEMI care. Treatment decisions should be individualized based on cognitive status, admission source, and patient goals.