260 - Prevalence of Cognitive Impairment (CI) in Hospitalized Heart Failure (HF) Patients Utilizing the Mini-Cog Assessment Tool

Abstract

Background: HF and CI are common medical conditions resulting in high hospital admissions and readmission rates. Both diagnoses are major healthcare problems leading to longer hospital length of stay, higher costs, and frequent readmissions. Objective: We present the prevalence of CI for patients admitted to the hospital with acute decompensated heart failure (ADHF) from a performance improvement project at our institution. Method: Three cardiology nurse practitioners (NP) formed the heart failure disease management (HFDM) service and provided a tailored assessment and intervention to patients admitted with HF including CI assessment in order to provide education with family for those with CI. The NP performed a 3-minute mini-cog assessment utilizing the standard mini-cog clock draw test (CDT) and 3-item recall test. Each word recalled was worth 1 point and the CDT was worth 2 points if completed correctly. A cutoff of < 3 points on the mini-cog assessment has been validated as a positive dementia screen and was used a positive CI score. Results: The HFDM NP saw 144 patients from December 2015 to February 2016. 136 patients had a completed mini-cog assessment documented. Nine patients seen refused to have a mini-cog assessment performed. 58% were male, 43% black with a mean age of 69 years old and an age range of 25 to 94 years. A positive cognitive deficit score of <3 points resulted in 32.4% of assessed patients evaluated. The 136 patients accounted for 347 total inpatient admissions within the hospital system within the past 4 years prior to the mini-cog assessment tool being utilized. Out of the 136 patients, 92 have a risk adjusted readmission rate of 13.64% (n = 6). Conclusion: The HFDM NP quality initiative validates that cognitive impairment with HF patients is a major contributor in hospital admissions with readmissions. 32.4% of the assessed patients has a score of < 3 points, indicating a CI. There is a continued need to assess the cognitive status of patients admitted to the hospital with HF. Further protocol care is instrumental in effective treatment of the underlying disease process for patients with a cognitive impairment. (Table 1, Table 2)Table 1Mini-Cog ScoreMini-Cog Score (0–5)N = 136 (CI %)0N = 22 (16.2%)1N = 9 (6.6%)2N = 13 (9.6%)3N = 14 (10.3%)4N = 7 (5.1%)5N = 71 (52.2%) Open table in a new tab Table 2Mini-Cog Score Divided into 4 QuartilesMini-Cog Score (0–5)1st QuartileMedian3rd Quartile4th QuartileGrand TotalAge (0–57)Age (58–69)Age (70–80)Age (81–95)033412221001892523313312741441222752223151171Grand Total3232324013625%16%25%58%32% Open table in a new tab