After STEMI catheterisation, over half of community-dwelling people with dementia spent 300+ days at home

Design

Retrospective national cohort, Medicare fee-for-service claims

Population

117,318 adults aged ≥65 with STEMI who had catheterisation, 2017–2022

Primary outcome

Adjusted days alive at home in the following year

Effect

Community dementia vs no dementia −37.8 days (95% CI −41.1 to −34.5); nursing home dementia −71.9 days; 1-year survival among nursing home admissions 42%

Using national Medicare claims, this study followed 117,318 adults aged 65 or over who came to the emergency department with STEMI between 2017 and 2022 and underwent cardiac catheterisation. It compared days alive at home over the next year by dementia status and by whether the patient came from a nursing home.

Among those living in the community, people with dementia spent an adjusted 38 fewer days at home than those without (about 225 vs 299), but more than half spent over 300 days at home. For people admitted from a nursing home, dementia was associated with markedly worse outcomes, 72 fewer days at home, and one-year survival among nursing home admissions was 42%.

The study included only those who had catheterisation, so patients with dementia who were judged unsuitable are not represented, and dementia severity was not measured. Even so, it challenges the reflex that a dementia diagnosis means invasive STEMI care is futile. The decision should turn on the person's function, where they live and what matters to them. It was published in September 2026.

• Do not let a dementia diagnosis alone rule out invasive STEMI care.
• Assess dementia severity, function before the event and where the person lives.
• Ask about the person's goals and prior wishes, involving family where appropriate.
• Be frank about the much poorer outlook for nursing home residents with dementia.
• Plan rehabilitation and support at home after the admission.

Why it matters

It challenges the assumption that invasive heart care is futile in people living with dementia.

Don't overread it

Only people who had catheterisation were included, so those judged unsuitable are missing from the comparison.

The statistics, in plain English

Days alive at home counts days not in hospital, a nursing facility or dead, which reflects what many patients value. An adjusted difference of −37.8 days (95% CI −41.1 to −34.5) is precise because the sample is large. Claims data cannot capture dementia severity, which strongly affects outcomes.

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