Table 3. Differences (95% Confidence Intervals) in composite summary measure of physicians' recommendations of guideline-concordant treatments and tests for acute ischemic stroke and acute myocardial infarction by cognitive status of clinical vignette patient.
| Cognitive Status of Clinical Vignette Patient | Acute ischemic stroke (neurologists, n = 49) based on 9 treatments and tests | Acute ischemic stroke (neurologists, n = 49) based on 4 treatments | Acute myocardial infarction (cardiologists, n = 33) | |||
|---|---|---|---|---|---|---|
| Unadjusted | Adjusted | Unadjusted | Adjusted | Unadjusted | Adjusted | |
| Patient MCI vs normal cognition | -0.16 (-0.31, 0.003) P = 0.06 | -0.13 (-0.29, 0.03) P = 0.10 | 0.16 (-0.36, 0.03) P = 0.10 | -0.14 (-0.35, 0.07) P = 0.19 | 0.03 (-0.17, 0.24) P = 0.75 | 0.01 (-0.27, 0.29) P = 0.96 |
| Patient early-stage dementia vs normal cognition | -0.34 (-0.50, -0.18) P<0.001 | -0.35 (-0.50, -0.20) P<0.001 | -0.39 (-0.59, -0.20) P<0.001 | -0.39 (-0.58, -0.19) P<0.001 | -0.16 (-0.34, 0.02) P = 0.09 | -0.21 (-0.46, 0.05) P = 0.11 |
| Age per 1-year increase | -0.001 (-0.008, 0.006) P = 0.82 | -0.006 (-0.01, 0.003) P = 0.20 | -0.003 (-0.01, 0.008) P = 0.60 | |||
| Women vs men | 0.09 (-0.05, 0.23) P = 0.19 | 0.12 (-0.06, 0.31) P = 0.19 | -0.04 (-0.33, 0.25) P = 0.76 | |||
| Whites vs non-Whites | -0.09 (-0.26, 0.07) P = 0.26 | -0.01 (-0.23, 0.20) P = 0.90 | 0.13 (-0.13, 0.39) P = 0.32 | |||
| Having close family/friend with dementia | 0.14 (-0.002, 0.28) P = 0.05 | 0.18 (-0.004, 0.37) P = 0.06 | -0.09 (-0.31, 0.12) P = 0.39 | |||
| AIS type | N/A | |||||
| Atrial fibrillation versus carotid stenosis | 0.10 (-0.02, 0.23) P = 0.11 | 0.09 (-0.08, 0.25) P = 0.29 | ||||
| AMI type | N/A | N/A | ||||
| High-risk NSTEMI vs STEMI | 0.11 (-0.11, 0.33) P = 0.32 | |||||
| Intermediate risk NSTEMI vs STEMI | 0.05 (-0.21, 0.31) P = 0.68 | |||||
| P value for trend across 3 cognitive groups* | <0.001 | <0.001 | <0.001 | <0.001 | 0.09 | 0.11 |
Abbreviations: AIS is acute ischemic stroke. AMI is acute myocardial infarction. NSTEMI is non-ST-elevation myocardial infarction. STEMI is ST-elevation-myocardial infarction. N/A is not applicable.
Linear regression models adjusted for physician age, gender, and having close family/friend with dementia as well as stroke/AMI type (stroke type: stroke with atrial fibrillation vs. stroke with high-grade carotid stenosis; AMI type: STEMI vs. high-risk NSTEMI vs intermediate-risk NSTEMI).
The nine stroke treatments and tests were IV t-PA within 3 hours, inpatient rehabilitation, statin, either carotid revascularization for high-grade ipsilateral carotid stenosis or anticoagulation for atrial fibrillation, carotid artery imaging, echocardiogram, admission to stroke unit, care by an inpatient stroke team, and long-term cardiac monitoring. The four stroke treatments were IV t-PA within 3 hours, inpatient rehabilitation, statin, and either carotid revascularization for high-grade ipsilateral carotid stenosis or anticoagulation for atrial fibrillation
*P-value for trend across 3 cognitive groups using Orthogonal polynomial contrasts test.