Abstract
BackgroundWe aimed to assess the utility of the combination of the mini-mental state examination (MMSE) + clock drawing test (CDT) and the Fried phenotype for predicting non-elective hospital readmission or death within 6 months in elderly inpatients with cardiovascular disease (CVD).MethodsA single-center prospective cohort was conducted from September 2018 to February 2019. Inpatients ≥65 years old were recruited. Predictive validity was tested using a Cox proportional hazards regression model analysis, and the discriminative ability was evaluated by the receiver operating characteristic (ROC) curve.ResultsA total of 542 patients were included. Overall, 12% (64/542) screened positive for cognitive impairment, 16% (86/542) were physically frail and 8% (44/542) had cognitive impairment combined with physical frailty, showing an older age (P < 0.001) and a lower education level (P < 0.001) than physically frail patients. A total of 113 patients (20.9%) died or were readmitted at 6 months. Frail participants with a normal (hazard ratio [HR]: 1.73, 95% confidence interval [CI]: 1.06–2.82, P = 0.028) or impaired cognition (HR: 2.50, 95% CI: 1.27–4.91, P = 0.008) had a higher risk of non-elective hospital readmission or death than robust patients after adjusting for the age, sex, education level, marital status, the presence of diabetes mellitus, heart failure, and history of stroke. The area under the ROC curve (AUC) showed that the discriminative ability in relation to 6 months readmission and death for the MMSE + CDT + Fried phenotype was 0.65 (95% CI: 0.60–0.71), and the AUC for men was 0.71 (95% CI: 0.63–0.78), while that for women was 0.60 (95% CI: 0.51–0.69).ConclusionsAccounting for cognitive impairment in the frailty phenotype may allow for the better prediction of non-elective hospital readmission or death in elderly inpatients with CVD in the short term.Trial registrationChiCTR1800017204; date of registration: 07/18/2018.
Highlights
We aimed to assess the utility of the combination of the mini-mental state examination (MMSE) + clock drawing test (CDT) and the Fried phenotype for predicting non-elective hospital readmission or death within 6 months in elderly inpatients with cardiovascular disease (CVD)
heart failure (HF) is slightly related to physical frailty
After adjusting for the age, sex, education level, marital status, presence of diabetes mellitus (DM), HF, and history of stroke, physical frailty (PF) and cognitive frailty (CF) were independently significant predictors of non-elective hospital readmission or death (HR: 1.73, 95% cognitive impairment (CI): 1.06–2.82, P = 0.028; hazard ratio (HR): 2.50, 95% CI: 1.27– 4.91, P = 0.008) in elderly inpatients with CVD (Fig. 2)
Summary
We aimed to assess the utility of the combination of the mini-mental state examination (MMSE) + clock drawing test (CDT) and the Fried phenotype for predicting non-elective hospital readmission or death within 6 months in elderly inpatients with cardiovascular disease (CVD). Cardiovascular disease (CVD) is the leading cause of death and disability [1]. Cardiovascular mortality in individuals 50 to 69 years of age was reported to be 436 deaths for every 100,000 people [2], increasing with age. CVD and related complications are significant healthcare problems in the growing elderly population. Age-associated cognitive decline and impairment have been shown to be associated with an increased mortality [8, 9]. Most previous reports only evaluated the relationship between physical frailty or cognitive impairment and CVD
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