Mild cognitive impairment predicts death and readmission within 30days of discharge for heart failure.
BACKGROUND Cognitive impairment is highly prevalent in heart failure (HF) and may be associated with short term readmission. This study investigated the role of cognition, incremental to other clinical and non clinical factors, independent of depression and anxiety, in predicting 30 day readmission or death in HF. METHODS This study followed 565 patients from an Australia wide HF longitudinal study. Cognitive function (MoCA score) together with standard clinical and non clinical factors, mental health and 2D echocardiograms were collected before hospital discharge. The study outcomes were death and readmission within 30days of discharge. Logistic regression, Harrell's C statistic, integrated discrimination improvement (IDI) and net reclassification index were used for analysis. RESULTS Among 565 patients, 255 (45% had at least mild cognitive impairment (MoCA<=22) Death (n=43, 8% and readmission (n=122, 21% within 30days of discharge were more likely to occur among patients with mild cognitive impairment (OR=2.00, p=0.001) MoCA score was also negatively associated with 30 day readmission or death (OR=0.91, p<0.001) independent of other risk factors. Adding MoCA score to an existing prediction model of 30 day readmission significantly improved discrimination (C statistic=0.715 vs. 0.617, IDI estimate 0.077, p<0.001) From prediction models developed from our study, adding MoCA score (C statistic=0.83) provided incremental value to that of standard clinical and non clinical factors (C statistic=0.76) and echocardiogram parameters (C statistic=0.81) in predicting 30 day readmission or death. Reclassification analysis suggests that addition of MoCA score improved classification for a net of 12% of patients with 30 day readmission or death and of 6% of patients without (p=0.002) CONCLUSIONS Mild cognitive impairment predicts short term outcomes in HF, independent of clinical and non clinical factors.
International journal of cardiology