Cognitive Domains and Post-Discharge Outcomes in Hospitalised Patients With Heart Failure

Abstract

Background: Cognitive impairment (CI) is an independent marker of readmission in heart failure (HF), but the screening is time-consuming. This study sought (1) to identify HF patients at low risk of cognitive impairment (obviating screening) and (2) to simplify a predictive model of HF outcomes by only using cognitive domains that are most predictive. Methods: Montreal Cognitive Assessment (MoCA) was performed in 1152 Australian HF patients who were followed for 12 months. One third (376/1152) of the patients were enrolled into an HF disease management plan (HF-DMP) to reduce early readmission. Post-discharge outcomes in HF included 30- and 90-day readmission or death, and days alive-and-out-of-hospital within 12 months of discharge. Results: Cognitive impairment – present in 54% of patients – independently predicted HF outcomes. Normal cognition could be predicted with common clinical and sociodemographic factors with good discrimination (C-statistic = 0.74 [0.69–0.78]). The Visuospatial/Executive and Orientation domains were most predictive of HF post-discharge outcomes. Using either MoCA score or these two domains provided similar incremental values (p = 0.0004 and p = 0.0008 respectively) in predicting HF outcomes (both C-statistic = 0.76), and could similarly identify a group of high-risk patients who benefited most from an HF-DMP. Conclusions: Cognitive function independently predicts HF outcomes, and may also contribute to how a patient responds to intervention. The time and resources spent on cognitive assessment for risk-stratification in HF may be minimised by (1) identifying patients with low risk of cognitive impairment and (2) simplifying the screening instrument to include only the domains that are most predictive of post-discharge outcomes in HF.