Emerging research suggests that appropriate use of amyloid positron emission tomography (PET) does not significantly reduce subsequent hospitalizations or emergency department (ED) visits for Medicare patients diagnosed with mild cognitive impairment.
For the non-randomized multisite study, recently published in JAMA Neurology, researchers assessed hospitalization and emergency department visit rates one year after the use of amyloid PET in 12,684 adults with mild cognitive impairment or dementia, and compared those rates to a control group of 12,684 people who did not have amyloid PET.
The researchers found that 44.8 percent of the amyloid PET group had ED visits within 12 months of the PET exam, and 44.8 percent of the control group had ED visits within the same time period. Twenty-four percent of the amyloid PET cohort were hospitalized during the 12-month study period in comparison to 25.1 percent of the control group, according to the study.
The study authors noted a 4.3 percent reduction in the hospitalization rate for those who had positive amyloid PET scans (21.4 percent) versus those who had negative amyloid PET scans (25.7 percent).
“Overall, these findings suggest that referral for amyloid PET had a possible association (which was below the prespecified threshold) with 12-month hospitalization rates but no association with 12-month ED visit rates,” noted lead study author Gil D. Rabinovici, M.D., who is affiliated with the Department of Neurology and the Memory and Aging Center at the Weill Institute for Neurosciences at the University of California, San Francisco (UCSF), and colleagues.
Three Key Takeaways
- Amyloid PET did not significantly reduce hospitalizations or ED visits. The study found that the appropriate use of amyloid PET did not lead to a significant reduction in subsequent hospitalizations or emergency department (ED) visits for Medicare patients diagnosed with mild cognitive impairment.
- Similar ED visit rates between amyloid PET and control groups. There was no significant difference in the rates of ED visits within 12 months between the group that had amyloid PET scans and the control group without amyloid PET scans.
- A modest reduction in hospitalization rates for positive amyloid PET scans. Positive amyloid PET scans were associated with a 4.3 percent reduction in hospitalization rates compared to negative amyloid PET scans, with a more pronounced effect in patients with dementia. However, this reduction did not reach the pre-specified threshold for significance.
The researchers did point out an overall 4.49 percent relative reduction in hospitalization rate for patients who had amyloid PET scans, a finding that was more pronounced in study participants with dementia.
“ … Greater integration and coordination of care, including the establishment of more standardized care pathways, could help better translate an early and accurate diagnosis into improved health outcomes for Medicare beneficiaries with cognitive impairment,” noted Rabinovici and colleagues.
Conceding the inherent limitations of a non-randomized controlled trial, the researchers explained that in matching the study cohort with a control group, there may have been confounding factors that affected the study findings. The study authors also pointed out that the study cohort had limited racial and ethnic diversity and was younger with fewer comorbidities in comparison to the general Medicare population with cognitive decline. A lack of access to Medicare Part D data for any of the study participants prohibited assessment of the impact of Alzheimer’s disease medications or other medications upon patient outcomes, according to the study authors.
