PS-BPC05-8: RELATIONSHIP BETWEEN EXECUTIVE DYSFUNCTION AND READMISSION IN PATIENTS WITH HEART FAILURE

Abstract

Objective: The prevalence of cognitive impairment is high in patients with heart failure and is associated with poor prognosis. Executive dysfunction can influence self-care control and adherence in patients with heart failure. We examined the relationship between executive dysfunction and hospital readmission in patients with heart failure. Design and Methods: Patients with heart failure were observed prospectively using a telemonitoring system. Cognitive impairment was evaluated using the Mini-Mental State Examination (MMSE) and executive dysfunction using the Trail Making Test B (TMT-B) at baseline. Cognitive impairment was defined as an MMSE score ≧ 23 points, and executive dysfunction was defined as a TMT-B score ≧ 180 s. We assessed relevant associations using the readmission rate. Results: Overall, 37 participants were studied. At a median follow-up of 19.5 months, 15 participants (40.5%) were re-hospitalized for worsening heart failure. Readmission rates for worsening HF were significantly higher in the executive dysfunction group (TMT-B ≧ 180 s) compared to the non-executive dysfunction group (TMT-B < 180 s; log-rank test, p = 0.005). Of the participants with no cognitive impairment (MMSE > 23), 11 had executive dysfunction while 19 did not. Readmission rates for worsening heart failure were higher in participants with cognitive impairment who had executive dysfunction (hazard ratio, 3.72; 95% CI, 0.87–15.8; p = 0.076). Multivariate analysis revealed that executive dysfunction was an independent risk factor for readmission due to heart failure (hazard ratio, 6.26; 95% CI, 1.01–38.4; p = 0.049). Conclusions: Executive dysfunction, as assessed by TMT-B, is associated with an increase of readmission in patients with heart failure. TMT-B may be useful in assessing the risk of readmission in patients with heart failure, as this is difficult to identify with general cognitive assessments.