Abstract 13814: Cognitive Impairment is Independent of Depression and Anxiety in Predicting Death and Readmissions Within 30 Days of Discharge for Heart Failure

Abstract

Background: Cognitive impairment, depression and anxiety are common in heart failure (HF). This study investigated the relationship of these factors with short-term outcomes in HF. Methods: This study included 343 HF patients from an Australia-wide longitudinal study of HF. Baseline clinical and administrative data, mental health (PHQ-9 and GAD-7 scores), cognitive function (MOCA score) and 2D echocardiograms were collected before hospital discharge. The study outcomes were death and readmission within 30 days of discharge. Logistic regression, Harrell’s C-statistic and integrated discrimination improvement were used for analysis. Results: Of 343 HF patients, 60 (17%) had severe depression (PHQ-9>15), 43 (12%) had severe generalized anxiety (GAD-7>15), and 233 (68%) were cognitively impaired (MOCA<26). PHQ-9 and GAD-7 scores were closely correlated (r=0.76 p<0.001), but were not associated with the MOCA score (r=0.00 and r=0.01 respectively). Within 30 days of discharge, 21 (6%) patients died and 77 (22%) and were readmitted. Death and readmission within 30 days of discharge were more likely to occur among patients with severe depression (odds ratio OR=2.52, p=0.007), severe anxiety (OR=2.46, p=0.01) and cognitive impairment (OR=2.80, p=0.001). After adjusting for standard clinical predictors included in the Yale prediction model, MOCA score (OR 0.87 p<0.001), PHQ-9 score (OR=1.06 p=0.003) and GAD-7 score (OR=1.06 p=0.002) remained predictive of HF 30-day readmission or death. Compared with a basic clinical predictive model, MOCA, GAD-7 and PHQ-9 scores provided incremental value (integrated discrimination improvement estimate 0.129, p<0.001) in predicting 30-day death and readmission among HF patients (see Figure). Conclusions: Depression/anxiety and cognitive impairment are independent and incremental to standard predictors of short-term outcomes in HF.