OBJECTIVES: Since February 2023, Veterans started to discuss the option of anti-amyloid therapy (AAT) for Alzheimer’s disease based on the United States Veterans Affairs Healthcare System (VAHS) established criteria for use. We examined documented reasons for not adopting AAT based on shared decision-making beyond VAHS criteria-based exclusions.

METHODS:: Ineligibility for AAT for reasons other than VAHS criteria for use were ascertained by manual review of computerized clinical notes in the VAHS nationwide databases (March 13, 2023–December 31, 2023). We targeted the chart review to identify reasons for not adopting AAT that resulted from shared decision-making between clinicians and patients.

RESULTS: Overall, 1668 patients were identified with an AAT-related clinical note. Initial review found 508 patient-initiated and 316 physician-initiated conversations regarding AAT. Among 629 patients considered ineligible for AAT at the time of the note (study window), 51% had mild cognitive impairment (MCI) and 34% had Alzheimer’s dementia (AD). The mean age was 76.8 years; 3% were Female, 9% were Black vs 83% White, and 4% were identified as Hispanic vs 92% non-Hispanic (4% unknown). Among patients with specific documentation of concerns regarding ATT, common barriers included lack of interest due to concerns regarding infusion, commuting, risk/benefit, or other issues (n=106) and lack of immediate access to AAT (n=30). Forty-eight clinicians recommended not pursuing the AAT. A portion of patients were postponing their decisions. Clinician types initiating AAT-related discussions included 258 neurologists, 73 geriatricians, 69 geriatric psychiatrists, 52 PCPs, and 38 nurses/nurse practitioners.

CONCLUSIONS: This analysis described ascertainable reasons for patient exclusion from AAT documented in VAHS clinical notes. Shared decision-making regarding AAT was documented between patients and clinicians in both specialty and primary care settings. Lack of patient interest was the most frequently documented reason for not adopting AAT. Institutional resource allocation may need to address access barriers.