HealthDay News — Physicians may miss factors associated with pulmonary embolism (PE), or fail to use these factors in making medical decisions, in patients who have dementia, according to a study published online Sept. 20 in the Journal of the American Geriatrics Society.
Dan P. Ly, M.D., Ph.D., and Paul G. Shekelle, M.D., Ph.D., both from the Veterans Affairs Greater Los Angeles Healthcare System, assessed emergency department visits to 104 VA hospitals (2011 to 2018) by patients ages 60 years and older presenting with shortness of breath. Associations of four clinical factors (deep venous thrombosis/PE, malignancy, recent surgery, and tachycardia) with PE testing were compared for patients with and without dementia.
The researchers found that 5.6 percent of the 593,001 patient visits included a diagnosis of dementia, and 10.6 percent received PE testing. Three of the four clinical factors were associated with lower PE testing for patients with dementia. Physicians were less likely to test patients with dementia for PE. Physicians were also less likely to test patients with dementia who had tachycardia compared with patients without dementia who had tachycardia. However, no clinical factor had a differentially lower association with a subsequently diagnosed acute PE for patients with dementia.
“These results may be consistent with physicians missing these clinical factors more often when evaluating patients with dementia, but also with physicians recognizing such factors but not using them in the decision-making process,” the authors write. “Further understanding how physicians evaluate patients with dementia presenting with common acute symptoms may help improve the care delivered to such patients.”