UC Irvine

Background: Patients with dementia have an average 2 to 8 additional comorbidities which may accelerate progression of cognitive and functional impairments in the under-diagnosed and under-treated conditions. Patients with dementia who visit the emergency departments (ED) more frequently are hospitalized more often than patients without dementia and have higher mortality after an ED visit than patients without dementia.

Methods: The Nationwide Emergency Department Sample (NEDS) for the years 2006-2010 was used for the present study. All samples with a diagnosis of Alzheimer’s disease (AD) or any of 18 comorbidities in the listed (n=15) ICD-9 diagnoses, and patients aged 55 years and above (35,429,235 samples) were included. The frequencies of 18 comorbidities being listed with the AD diagnoses in the died-in-visit AD sample and their impacts on the likelihood of AD patients died-in-visit were investigated.

Results: In the whole sample, the mean age was 71.33 years, 57.2% were female. The number of patients with AD is 754011 (2.1%). Hypertension is the most frequent diagnosis in total samples (14343260, 40.5%) and in AD samples (379507, 50.3%). The number of total patients died-in- visit is 672722 (1.8%). The number of total AD patients died-in-visit is 26603 (4.0%). Hypertension is the most frequent diagnosis in total samples (40.5%) and in AD samples (50.3%); As for died-in-visit AD samples, dysrhythmias (52.5%) is the most frequent diagnosis followed by hypertension (30.3%), atherosclerosis (23.1%), chronic heart disease (12.7%) hypotension (8.6%), COPD (8.3%), brain hemorrhage (4.2%), and asthma (3.9%). AD patients have increased likelihood of dying with brain hemorrhage (OR = 7.06; 95% CI, 6.51 – 7.65, p < 0.001), hypotension (OR = 2.49; 95% CI, 2.36 – 2.63, p < 0.001), dysrhythmias (OR = 2.48; 95% CI, 2.40 – 2.55, p < 0.001), gastrointestinal ulcer (OR = 1.26; 95% CI, 1.02 - 1.55, p=0.032), diabetes mellitus (OR = 1.21; 95% CI, 1.16 - 1.27, p < 0.001), and atherosclerosis (OR = 1.08; 95% CI, 1.04 - 1.13, p < 0.001).

Conclusions: cardiovascular comorbidities are overwhelmingly common in AD patients died-in-visit after being admitted to ED. Screening newly admitted AD patients in ED for these comorbidities may help address them early and reduce the likelihood of dying-in-visit.