Abstract 4370696: Patients with Dementia admitted for Heart Failure Demonstrate Worse Clinical and Patient-centered Outcomes

Abstract

Introduction/Background: The incidence of heart failure (HF) among patients with Alzheimer’s disease and related dementias (ADRD) is expected to increase due in part to shared risk factors in an aging population. Despite this, outcomes of HF in patients with ADRD are underexplored. The aims of this study are to assess clinical and patient-centered outcomes following admission for HF as stratified by dementia status. Methods/Approach: This retrospective cohort study identified patients 65 years or older in the OneFlorida+ data trust with first admission for HF between October 1, 2015 and December 31, 2022. ICD-10 diagnoses codes were used to identify HF, ADRD, and relevant comorbidities. Exclusion criteria were admission with STEMI or shock. The primary clinical outcome was all-cause 1-year mortality, and the secondary clinical outcome was 90-day readmissions. Patient-centered outcomes were length of stay and discharge home. Results/Data: 22,342 patients with first HF hospitalization during the study period were identified. Of these, 5,261 (23.5%) patients carried a diagnosis of ADRD. Patients with ADRD were more likely to be women (57.7% vs. 53.1%, p<0.05) and Black (21.1% vs. 14.6%, p<0.05). 1-year mortality was higher in patients with ADRD ( HR 1.22, 95% CI 1.10-1.36, p < 0.005) as was 90-day re-admissions (HR 1.23, 95% CI 1.18-1.28, p <0.005). Patients with ADRD demonstrated longer lengths of stays (5.7 vs. 5.4 days, p <0.005) and were less likely to be discharged home (OR .649, 95% CI -0.469- -.395, p<0.005). Conclusions: Patients with ADRD hospitalized with HF demonstrate higher 1-year mortality and 90-day re-admissions. Patient-centered outcomes are also worse, as patients with ADRD have longer lengths of stay for HF and are less likely to be discharged home. These findings should be used to identify research priorities and to facilitate advanced care planning in patients with ADRD and HF.