Impact of coronary interventions on dementia diagnosis by race: Insights from a multi-hospital heart-brain registry

Abstract

Background

Racial and ethnic disparities have been reported with coronary artery disease as well as dementia and Alzheimer's disease (AD) related diagnoses.

Objective

To investigate the disparities concerning coronary interventions and the incidence of non-vascular and AD-related dementia diagnoses within a multi-site healthcare network.

Methods

Utilizing the EMR-acquired Heart-Brain registry in a multi-site healthcare network in Western Pennsylvania, we analyzed patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) between 2010 and 2020. We assessed the incidence of ‘likely’ non-vascular dementia, including AD-related diagnosis, over a median follow-up of six years. Baseline covariates were summarized using means and medians. Multivariable adjusted Cox regression hazard ratios (HR [95% CI]) were used to examine the association between incident ‘non-vascular dementia and AD-related diagnosis with the type of coronary intervention, stratified by self-reported race.

Results

Among 47,210 patients, 71.6% (n = 33,822) underwent PCI and 28.4% (n = 13,388) underwent CABG. Overall, the risk of likely non-vascular dementia diagnosis was higher among Black patients (HR = 1.26 [1.02–1.56]; p = 0.035). In stratified analysis by procedure, Black patients with CABG history had greater risk of non-vascular dementia (HR = 1.85, 95% CI [1.29–2.66]; p = 0.020), and AD related diagnosis (HR = 1.73, 95% CI [1.16–2.58]; p = 0.007); than White patients.

Conclusions

Black patients who undergo CABG may be at a higher risk of non-vascular dementia incidence. More research is needed to evaluate the mechanisms of this finding and develop precise risk mitigation strategies to prevent dementia risk.

Graphical abstract

This is a visual representation of the abstract.

Keywords

Alzheimer's disease atherosclerotic cardiovascular disease coronary artery bypass graft coronary artery revascularization dementia percutaneous coronary artery intervention social determinants of health

Introduction

Coronary artery disease (CAD) and its risk factors are associated with dementia incidence.^1–5 There may even be an overlap between hypertension and dyslipidemia, two primary risk factors for CAD, with non-vascular dementia, such as Alzheimer's disease (AD) and related diagnoses. AD is the leading cause of cognitive decline in the US population >65 years.⁶ Alterations in the cerebral circulation, such as those seen in patients with CAD, have been implicated in the development of AD.^7,8 This, early identification of AD and its risk factors is necessary for strategies focused on the prevention of dementia and its progression.

Racial and ethnic disparities have been previously reported with CAD in terms of adherence to medical therapy for primary prevention. Black and Latino individuals are reported to have suboptimal CAD preventive therapy utilization.^9–12 While less data are available on disparities for secondary prevention, certain aspects have shown a degree of progress, notably, in cholesterol control, prescription of statins, and smoking cessation in Hispanic and Latino individuals. However, racial and ethnic disparities persist¹³ and individuals who are Black or Hispanic have higher rates of uninsured status and thus lack of regular provision of healthcare.^14–16 This is further compounded by social determinants of health (SDoH), namely education and employment, among others.^17–19

While there are scientific and clinical advances in care of AD and related diagnoses, the nature of the disease poses challenges given its heterogenous risk factors and presentation. This renders early recognition challenging.²⁰ Significant disparities have been noted when examining the sociodemographic distribution of AD dementia.²⁰ Black individuals have a higher risk of all-cause dementia, including AD—a statistic that is similar to their relative risk of CAD compared to White individuals.^21,22 Indeed, neuropathological differences have been observed among racial groups, indicating that the underlying mechanisms of AD-related diagnosis may vary by race.^23,24 Yet, it is unknown whether there are any race-related disparities in the incidence of non-vascular dementia in patients with known CAD. These differences, when coupled with SDoH, can potentially affect the procedural choice and efficacy of surgical and medical interventions for CAD in high-risk patients.

In this study, we investigated the risk of non-vascular dementia diagnosis and racial disparities within an electronic health record (EHR) recruited cohort of Black and White patients with coronary interventions (percutaneous coronary intervention [PCI] and coronary artery bypass graft [CABG]) across a multi-site healthcare system.

Methods

Study population

A cohort of patients with established CAD (underwent either PCI or CABG) was examined over the course of 10 years, from 2010 to 2020 in a multi-hospital healthcare system of University of Pittsburgh Medical Center (UPMC) spanning ∼35 inpatient and >200 hospital sites. We have previously published detailed methods on data acquisition.²⁵ Briefly, medical data was captured through structured administrative and clinical databases and an EHR, which are all integrated into UPMC's Clinical Data Warehouse (CDW).

The date of indexed PCI or CABG procedure at a UPMC facility served as the baseline date of entry to the cohort. Patients with prior history or diagnosis of dementia and acute ischemic/thrombotic strokes were excluded from the current study. All included patients had at least one baseline covariates data available in the system for review.

Study covariates and outcomes

Baseline characteristics of the study population were defined using data within 180 days of the index date of entry into the cohort. These included sociodemographic data (age, sex, and race/ethnicity, Elixhauser comorbidity score (a set of 30 comorbidity indicators)(16), low-density lipoprotein cholesterol, and the remaining pooled cohort equation (PCE) variables including; total cholesterol, high-density lipoprotein cholesterol, treatment for hypertension, systolic blood pressure, current smoking status, and diabetes.²⁶

Medications including statin and aspirin use was assessed. Laboratory values were assessed at the time of first interaction with the system and nearest to diagnosis of outcome, those included lipid panel, high sensitivity C reactive protein (hsCRP), beta natriuretic peptide (BNP), troponin, hemoglobin and hemoglobin A1C.

Outcomes in the “Heart-Brain Registry”

Incidence of “likely non-vascular dementia” diagnosis was included as the primary outcome of interest through a comprehensive review of ICD 9 and 10 codes throughout the UPMC CDW among patients with known coronary artery disease. “Likely non-vascular dementia” included a composite ICD 9 and 10 codes for global cognitive impairment incidence, global dementia incidence, global mild cognitive impairment (MCI) incidence and frontotemporal dementia and deficits with undetermined causes. We additionally, also explored an EHR based “likely Alzheimer's disease (AD)” outcome including use of any of the memory medications (including donepezil, rivastigmine, donepezil/memantine, galantamine, and tacrine) in addition to ICD9 and ICD10 codes for AD related diagnosis (Supplemental Table 1).

Statistical analysis

Baseline descriptive statistics of the study sample, such as the minimum, maximum, median, and mean for each continuous variable and frequency table for each categorical variable, were initially analyzed to summarize the data and detect outliers and missing values. Missing data where common were replaced by the mean imputation across the risk groups. Descriptive characteristics are presented as mean and SD for continuous variables, and frequencies and proportions for categorical variables. Pearson's Chi-square test was utilized for categorical comparisons. For continuous variables, student's t-test were employed. Kaplan Meier estimates were utilized to model incidence of likely non-vascular dementia/ likely AD comparing the different groups. Cox regression hazard ratios (HR) [95% CI] were calculated for association of the type of CAD event (PCI, CABG) with first all-dementia and then AD related diagnosis; adjusted for all baseline covariates and stratified by age, race/ethnicity (Black, White), sex (male, female), smoking status, body mass index (BMI), pulse, blood pressure, hypertension treatment, diabetes, total cholesterol, HDL-C, LDL-C, treatment with aspirin, and statin, Van Walraven score. The proportional-hazards assumption was evaluated by the Schoenfeld residual plot, and no significant violations were identified. All analysis were conducted using SAS Analytics Software. Statistical significance was set at α=0.05. All tests of statistical significance were 2-tailed.

Samples were matched based on propensity scores estimated from covariates including age, sex, smoking status, and medical history (diabetes, hypertension, coronary artery disease, stroke, obesity, depression, hypothyroidism, alcohol abuse), as well as total cholesterol and LDL-C levels. To account for selection bias, propensity matching was used at a 1:4 ratio without replacement, where each patient in the Black population was matched with up to four patients in the White population. A caliper width of 0.2 standard deviations of the logit of the propensity score was applied to ensure high-quality matches. To assess the balance of baseline characteristics between matched groups, standardized mean differences (SMDs) were calculated before and after matching. An absolute SMD less than 0.1 was considered indicative of adequate covariate balance. Kaplan–Meier estimates of dementia and Alzheimer's disease rates over time in the propensity score–matched sample were conducted as well.

Results

Study population and baseline characteristics

A total of 47,210 patients with established CAD were included in the study where 71.6% (n = 33,822) underwent PCI and 28.4% (n = 13,388) underwent CABG (Figure 1).

Figure 1.

Graphical representation of study cohort and subgroups. CAD: coronary artery disease; PCI: percutaneous coronary artery intervention; CABG: coronary artery bypass graft.

Baseline characteristics are shown in Table 1 (by coronary intervention type) and Supplemental Table 2 (by self-identified race). Mean age for the PCI cohort was 68.8 ± 10.2 years while it was 68.7 ± 8.96 for the CABG cohort. More men underwent primary PCI or CABG compared to women (68% and 74% respectively; p < 0.01). The PCI cohort had higher prevalence of smoking (p = 0.002), while the CABG group had higher systolic blood pressure, they were more likely to be on anti-hypertensive treatment and to have diabetes (p < 0.001). Patients who underwent CABG had lower TGs and higher HDL-C (p = 0.009 and p < 0.001 respectively), they were more likely to be using aspirin (p = 0.002). The PCI cohort were found to have higher LDL-C levels (p < 0.001), and higher Van Walraven scores for comorbidities (p < 0.001).

Table 1.

Baseline characteristics of patient population (stratified by revascularization procedure).

	PCI (n = 33822)	CABG (n = 13388)	p
Age	68.8 ± 10.2	68.7 ± 8.96	0.294
Sex			<0.001
Male (n, %)	22962 (67.89)	9858 (73.63)
Female (n, %)	10860 (32.11)	3530 (26.37)
Race			<0.001
White (n, %)	31018 (91.71)	12301 (91.88)
Black (n, %)	1674 (4.95)	576 (4.30)
Other (n, %)	1130 (3.34)	511 (3.82)
Current smoking (n, %)	4582 (13.55)	1673 (12.50)	0.002
BMI	30.3 ± 6.18	30.4 ± 6.03	0.053
Pulse (beats per minute)	75.6 ± 12.3	83.9 ± 11.4	<0.001
Systolic BP (mmHg)	135 ± 16.6	139 ± 19.1	<0.001
Diastolic BP (mmHg)	74.9 ± 9.63	71.6 ± 10.3	<0.001
Hypertension treatment	18806 (55.60)	7951 (59.39)	<0.001
Diabetes (n, %)	7734 (22.87)	3253 (24.30)	<0.001
Total cholesterol (mg/dL)	159 ± 44.6	154 ± 45.9	<0.001
Triglycerides (mg/dL)	144 ± 91.5	141 ± 87.6	0.009
HDL-C (mg/dL)	41.9 ± 12.5	40.9 ± 12.5	<0.001
LDL-C (mg/dL)	89.3 ± 37.5	85.9 ± 37.9	<0.001
Current Statin (n, %)	15640 (46.24)	6710 (50.12)	<0.001
Current Aspirin (n, %)	15140 (44.76)	6514 (48.66)	<0.001
Van Walraven score	2.69 ± 5.07	2.11 ± 4.52	<0.001

CAD: coronary artery disease; PCI: percutaneous coronary artery intervention; CABG: coronary artery bypass graft, BMI: body mass index; BP: blood pressure; HDL-C: high density lipoprotein cholesterol; LDL-C: low density lipoprotein cholesterol.

p < 0.05.

Patients with likely non-vascular dementia were older (75.0 ± 8.57, p < 0.001). They tended to have higher use of anti-hypertension medical management (60.17% versus 56.54%, p = 0.003), statin use (50.20% versus 47.23%, p = 0.015) and aspirin use (52.23% versus 45.63%, p < 0.001). It was noticed that patient with a non-vascular dementia diagnosis had lower triglycerides (p < 0.001), LDL-C (p = 0.043), higher HDL-C (p < 0.001). They were more likely to have a higher Van Walraven scores for comorbidities (p < 0.001) (Supplemental Table 1). Similarly, patients with AD related diagnosis were older (75.4 ± 8.32, p < 0.001), had higher use of anti-hypertension medical management (60.17% versus 56.54%, p = 0.003) and aspirin use (52.23% versus 45.63%, p < 0.001) than those without dementia.

Out of the group with likely non-vascular dementia diagnosis- 1615 were White and 91 were Black by self-report in the EMR system. Baseline characteristics of these patients are shown in Supplemental Table 2. The mean age for White patients was 75.2 ± 8.53 years while it was 72.0 ± 8.98 for Black patients. Black patients had higher systolic and diastolic blood pressure (p < 0.05) and they smoked more (p = 0.004). Additionally, they had higher prevalence of diabetes (p < 0.05).

The mean time from diagnosis to onset of non-vascular dementia or likely AD was similar among both groups at 3.95 ± 3.00 (White) versus 3.79 ± 2.99 years (Supplemental Table 2). In Kaplan Meir probability curves, we found that Black patients had a higher probability of non-vascular dementia incidence when undergoing CABG while such an association was not significant for PCI (Figure 2(a), b). There was no statistically significant difference in probability of AD related diagnosis incidence among the two groups (Figure 2(c), d).

Figure 2.

Kaplan Meier probability curves for non-vascular dementia and Alzheimer's disease (AD) related diagnosis by procedure type. (a) Non-vascular dementia with PCI; (b) Non-vascular dementia with CABG; (c) AD related diagnosis with PCI; (d) AD related diagnosis with CABG. PCI: percutaneous coronary artery intervention; CABG: coronary artery bypass graft; AD: Alzheimer's disease.

On assessment of the risk of non-vascular dementia and AD related diagnosis, no significant risk related to CABG versus PCI was identified for non-vascular dementia (HR = 0.93, 95% CI [0.83–1.03]; p = 0.171) and for AD related diagnosis (HR = 0.93, 95% CI [0.83–1.05]; p = 0.23) (Table 2). In fully adjusted HR models for PCE variables²⁷ (Table 3), Black patients had a higher risk of non-vascular dementia diagnosis (HR = 1.26, 95% CI [1.02–1.56]; p = 0.035) compared to their White counterparts. A non-significant signal of association was noted in the secondary outcome specific to AD related diagnosis (HR = 1.15, 95% CI [0.91–1.46]; p = 0.25) (Table 3). In an interaction analysis stratified by procedure type, we found that the elevated risk of non-vascular dementia and AD related diagnosis incidence in Black patients was associated with the CABG procedure for non-vascular dementia (HR = 1.85, 95% CI [1.29–2.66]; p = 0.020) and AD related diagnosis (HR = 1.73, 95% CI [1.16–2.58 ]; interaction p = 0.007) (Table 4).

Table 2.

Multivariate adjusted HR of CABG versus PCI for non-vascular dementia and AD related diagnosis.

Parameter	HR	95% Hazard Ratio Confidence		p
Non-vascular dementia	0.93	0.83	1.03	0.171
AD related diagnosis	0.93	0.83	1.05	0.231

PCI: percutaneous coronary artery intervention; CABG: coronary artery bypass graft; AD: Alzheimer's disease.

Table 3.

Risk of non-vascular dementia and Alzheimer's disease related diagnosis in Black versus White patients with coronary artery disease intervention.

Parameter	HR	95% Hazard Ratio Confidence		p
Non-vascular dementia	1.26	1.02	1.56	0.035
AD related diagnosis	1.15	0.91	1.46	0.252

Model adjusted for traditional Pooled Cohort Equation (PCE) variables including sex, age, race, total and high-density lipoprotein-cholesterol (HDL-C), systolic blood pressure, blood pressure treatment status, smoking status, and diabetes status.

AD: Alzheimer's disease.

Table 4.

Association of race and dementia/AD related outcomes stratified by revascularization procedure.

Contrast	Estimate	Confidence Limits		Pr > ChiSq
Non-vascular dementia Risk
Black versus White at PCI	1.07	0.82	1.39	0.620
Black versus White at CABG*	1.85	1.29	2.66	<0.001
AD related diagnosis Risk
Black versus White at PCI	0.96	0.72	1.29	0.806
Black versus White at CABG*	1.73	1.16	2.58	0.007

*p = 0.020 for interaction between CABG and race in dementia, p = 0.03 for interaction between CABG and race in AD.

PCI: percutaneous coronary artery intervention; CABG: coronary artery bypass graft; ADRD: Alzheimer's disease related dementias.

To account for selection bias, propensity matching was used at a 1:4 ratio without replacement. In our matched sample, all absolute SMDs were below 0.05, indicating excellent balance (Supplemental Table 4, Supplemental Figure 1). The results from the propensity score graphs align with Figure 2.

Discussion

In this study, we examined a real-world cohort of patients with established CAD who underwent percutaneous or surgical coronary interventions and subsequently EMR-based surveillance for non-vascular dementia and AD-related diagnosis over a median follow-up period of six years. Our study reveals three significant observations: a) there was no notable difference in the risk of dementia diagnosis between patients undergoing CABG or PCI across the overall population; b) the median time to overall dementia diagnosis was shorter for PCI patients (3.5 years) compared to CABG patients (approximately 4 years); however, c) Self-reported Black patients who underwent CABG exhibited more than 60% higher risk of incident non-vascular dementia and AD related diagnosis (p-value for interaction <0.05).

To our knowledge, this is the first study to highlight such differences in the outcomes of AD related diagnosis and non-vascular dementia diagnosis based on the type of coronary intervention among patients with known CAD. Previous data suggest that CABG poses a higher risk of cognitive decline.^28–30 However, there are virtually no data assessing the risk of non-vascular dementia incidence by type of coronary intervention in patients with CAD across demographic subgroups in such procedures. Enumah et al. have previously reported that Black individuals have significantly worse 30-day outcomes post-CABG (including higher mortality, infections, strokes, and others), even after adjusting for different comorbidities (11 times higher odds of death for a Black person).³¹ Even with adjustment for hospital quality and socioeconomic status, this did not account for the difference in mortality, highlighting possible biological etiologies that remain unexplored.^32,33

Several mechanisms have been implicated in previously noted higher risk of dementia related to CABG.³⁴ First, as it is an invasive procedure, with general anesthesia and longer operative time, which may be associated with hypoperfusion state during cardiopulmonary bypass and ischemic brain injury.^34,35 Second, inflammatory cytokine release after CABG has been hypothesized to be related to post-operative cognitive decline.³⁶ Since CABG is usually more preferred for patients with diabetes, left ventricular systolic dysfunction and higher syntax scores denoting a more complex or extensive atherosclerotic cardiovascular disease, it is plausible that such comorbidities could impact the higher risk for future cognitive decline.³⁷ However, most of these dementias were secondary to gross vascular disease, which was excluded from our outcomes. Furthermore, recent advances in operative techniques have significantly reduced risk of dementia and brain pathology in patients undergoing CABG procedures.^38–40 While multiple studies have explored the cognitive outcomes after CABG, none of these studies have stratified cognitive outcomes by racial subgroups.

Given the above, other reasons for such a discrepancy in risk of non-vascular dementia diagnosis in Black patients across our cohort should be explored. There is a significant association of SDoH leading to suboptimal care in minority patients across the United States.^41,42 Black, Asian American, Native American and Hispanics have been reported to have several barriers limiting their diagnosis with cognitive decline and AD, and when sought, limitations to the provided care and treatment.⁴³ Whether the worse cognitive outcomes can be solely attributed to racial or ethnic disparities or rather to other biological factors remains unexplored.

Black individuals acquire large artery stiffening, an independent contributor to cognitive decline, earlier and sometimes in an accelerated fashion.^44,45 To be noted, in our population, the rates of diabetes were nominally higher in those with dementia and/or AD than without.

Our results, if replicated, may have important clinical implications. First, several mitigating strategies can be implemented to facilitate early diagnosis and provide care for Black patients undergoing CABG. Screening for delirium (such as the 4AT test, Confusion Assessment Method–ICU, or Delirium Observation Screening Scale might be of value in the periprocedural time frame.^30,46,47 Common formal neuropsychological test batteries applied post-CABG can be ideally administered pre-operatively, at discharge, and periodically up to 6 months.^48–50 When older CABG patients received Computerized Cognitive Training pre- and post-op, they had improved memory and attention at 3 months (effect size η²=0.50).⁴⁷ These interventions are promising, low-cost, and scalable, despite that they may not address all underlying factors causing disparities, and more research is needed in this regard.

Future studies could track dementia risk in patients undergoing CABG prospectively. A minimized time off-pump or intraoperative risk mitigation strategies in patients with multiple co-morbidities may be useful. All these risk mitigation strategies are presumptive, require resources by hospital systems, and at present remain untested in randomized clinical trials.

Our study has notable strengths, namely the large sample size with definitive coronary artery disease by procedural history and the long follow-up duration of 6 years across an integrated healthcare system with academic and private practice models in rural and urban areas. However, some limitations apply and must be detailed. Differentially, more non-Hispanic White patients were involved in this analysis, when compared to Black patients. Our sample lacked sufficient representation of patients identifying as Black, this sampling bias may limit the generalizability of our findings and impact the applicability of results to this demographic. There is a critical need to address the persistent underrepresentation of Black patients in clinical research, including the work presented here, to limit future disparities in evidence-based care. Although the study offers valuable insights, a more balanced representation might yield different outcomes. Assessing cognitive decline is challenging without a baseline cognitive assessment, which is lacking in many studies. Although overall vascular dementia and ischemic/thrombotic strokes were excluded from this study, the exclusion of subclinical neuro-vascular disease is unattainable in a pure HER-based sample. Additionally, other ethnic minorities were not included; the study subjects are localized to the greater Pennsylvania region which poses some challenges when it comes to generalizing outcomes. In this study, ICD codes and medications were used to define “likely non-vascular dementia”. This is primarily attributed to intertwined challenges in screening for and diagnosing cognitive decline and dementia, and the multiple comorbidities associated with cognitive decline.^51,52 Resource constraints (i.e., access to memory clinics), inadequate training, and diagnostic ambiguity, fear, denial, and stigma lead to delays in recognizing dementia.^53,54 There are barriers to equity in dementia care due to language barriers and racial disparities.⁵⁵ Additionally, diagnosis can be limited by costly diagnostic tools.⁵⁶ The scarcity of studies begets the need for more studies to identify ethnic-specific AD and related diagnoses screening behavior, and thus interventions.⁵⁷

Finally, although robust statistical modeling was utilized, due to geographical and racial sample limitations our results are correlative and serve as an important signal for future replications in independent cohorts. With the inconsistency reported across the literature, it is arduous to draw final conclusions on the association of coronary artery revascularization and long-term non-vascular cognitive outcomes. Many gaps remain, necessitating further prospective studies in understanding long-term outcomes following coronary artery revascularizations, risk factors modifications, biological etiologies of racial disparities and possible preventive measures/post-procedural protocols.

Conclusion

In this EHR leveraged dataset across a multi-hospital health system, Black patients with known coronary artery disease had a higher risk of dementia and AD-related diagnosis after coronary intervention, a risk primarily driven by CABG intervention. Future studies should aim to validate these findings across heterogeneous patient populations and test mitigation strategies to lower dementia risk in patients with coronary artery disease.

Clinical perspectives

Our study shows that Black patients who underwent CABG exhibited a more than 60% higher risk of non-vascular dementia and AD-related diagnosis. This should promote risk mitigating strategies, including pre-operative cognitive testing and close post-operative follow-up, especially in Black population.

Supplemental Material

sj-docx-1-alz-10.1177_13872877251409341 - Supplemental material for Impact of coronary interventions on dementia diagnosis by race: Insights from a multi-hospital heart-brain registry

Supplemental material, sj-docx-1-alz-10.1177_13872877251409341 for Impact of coronary interventions on dementia diagnosis by race: Insights from a multi-hospital heart-brain registry by Alaa Sayed, Jianhui Zhu, Floyd Thoma, Ann D. Cohen, Steven Reis, Oscar L. Lopez, Ibrahim Sultan, Chris McKennan, Suresh R Muluktla, Tharick Pascoal and Anum Saeed in Journal of Alzheimer's Disease

Supplemental Material

sj-docx-2-alz-10.1177_13872877251409341 - Supplemental material for Impact of coronary interventions on dementia diagnosis by race: Insights from a multi-hospital heart-brain registry

Supplemental material, sj-docx-2-alz-10.1177_13872877251409341 for Impact of coronary interventions on dementia diagnosis by race: Insights from a multi-hospital heart-brain registry by Alaa Sayed, Jianhui Zhu, Floyd Thoma, Ann D. Cohen, Steven Reis, Oscar L. Lopez, Ibrahim Sultan, Chris McKennan, Suresh R Muluktla, Tharick Pascoal and Anum Saeed in Journal of Alzheimer's Disease

Supplemental Material

sj-docx-3-alz-10.1177_13872877251409341 - Supplemental material for Impact of coronary interventions on dementia diagnosis by race: Insights from a multi-hospital heart-brain registry

Supplemental material, sj-docx-3-alz-10.1177_13872877251409341 for Impact of coronary interventions on dementia diagnosis by race: Insights from a multi-hospital heart-brain registry by Alaa Sayed, Jianhui Zhu, Floyd Thoma, Ann D. Cohen, Steven Reis, Oscar L. Lopez, Ibrahim Sultan, Chris McKennan, Suresh R Muluktla, Tharick Pascoal and Anum Saeed in Journal of Alzheimer's Disease

Footnotes

Acknowledgements

The authors acknowledge the contributions of Hongtian Wang as the editor of this paper. Permission has been asked from Ms. Wang for mention in this acknowledgement.

ORCID iDs

Alaa Sayed

Jianhui Zhu

Chris McKennan

Suresh R Muluktla

Anum Saeed

Ethical considerations

This study involved secondary analysis of deidentified EHR data. No personal identifiers were accessed, and no attempt was made to reidentify individuals. All study procedures complied with the ethical standards of the institution and with the principles outlined in the Declaration of Helsinki.

Consent to participate

This study was approved by the Quality Improvement and Institutional Review Board committees. This study was restricted to secondary data analysis, and thus, the requirement for informed consent from participants was waived.

Consent for publication

Not applicable

Author contribution(s)

Alaa Sayed: Visualization; Writing – original draft; Writing – review & editing.

Jianhui Zhu: Formal analysis.

Floyd Thoma: Data curation.

Ann D. Cohen: Writing – review & editing.

Steven Reis: Writing – review & editing.

Oscar L Lopez: Conceptualization; Writing – review & editing.

Ibrahim Sultan: Writing – review & editing.

Chris McKennan: Writing – review & editing.

Suresh R Muluktla: Writing – review & editing.

Tharick Pascoal: Conceptualization; Methodology; Writing – review & editing.

Anum Saeed: Conceptualization; Investigation; Methodology; Supervision; Writing – review & editing.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Anum Saeed is supported by American Heart Association Career Development Award Number: 23CDA1055489.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

The data supporting the findings of this study may be available upon reasonable request.

Supplemental material

Supplemental material for this article is available online.

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