Abstract 18993: High Prevalence of Cognitive Impairment in Older Heart Failure Patients at Hospital Discharge
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abstract
Background:
Evidence suggests that HF patients do not consistently engage in self-care. One possible reason may be the presence of undetected mild cognitive deficits (MCD). The primary objective of this study was to prospectively evaluate whether MCD measured with the Montreal Cognitive Assessment (MoCA) test in HF patients aged ≥60 years at hospital discharge is associated with impaired ability to self-care (measured with the Self-Care Heart Failure Index (SCHFI), patient is considered adequate if score ≥70/100).
Methods
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Results:
We prospectively recruited HF patients within 48 hours from hospital discharge. In addition to the assessment of cognitive function, we measured baseline intelligence (NAART35), depression (Geriatric Depression Scale,
GDS15
), caregiver burden (modified Oberst Caregiver Burden Scale), activities of daily living (Barthel index), and frailty (Clinical Frailty Scale, CFS). We have recruited 51 patients (mean age 78, SD 7 years, 51% male) in this study. Sixty eight percent of patients have a high school education or less, 45% are married, 42% widowed, and 64% of patients have a total household income of <$40,000. Fifty three percent of patients have a left ventricular ejection fraction >45%. The mean number of medications at hospital discharge is 10 (SD 4). The mean MoCA score at baseline was 22 (SD 4) and 87% of patients had a MoCA score <26 (indicating cognitive impairment). The SCHFI at baseline was 64 for self-maintenance, 46 for self-management, and 63 for self-confidence. Caregiver burden was low for the 2 subscales (Demand: 1.9, Difficulty: 1.3). The mean score for the
GDS15
was 4/15 (no depression: 0-4/15), Barthel index was 82/100 indicating that the patients are not fully independent for ADLs. The mean CFS score was 4/7 indicating that these individuals are limited by symptoms during their activities.
Conclusion:
To our knowledge, this is the first prospective study at hospital discharge indicating a high prevalence of cognitive impairment. These results suggest that older HF patients have significant undetected cognitive deficits which may impact on their ability to self-care, which may in turn potentially lead to re-hospitalization early after hospital discharge.
