title: Mild cognitive impairment predicts death and readmission within 30days of discharge for heart failure.
abstract: BACKGROUND
  Cognitive impairment is highly prevalent in heart failure (HF), and may be associated with short-term readmission. This study investigated the role of cognition, incremental to other clinical and non-clinical factors, independent of depression and anxiety, in predicting 30-day readmission or death in HF.
  
  
  METHODS
  This study followed 565 patients from an Australia-wide HF longitudinal study. Cognitive function (MoCA score) together with standard clinical and non-clinical factors, mental health and 2D echocardiograms were collected before hospital discharge. The study outcomes were death and readmission within 30days of discharge. Logistic regression, Harrell's C-statistic, integrated discrimination improvement (IDI) and net reclassification index were used for analysis.
  
  
  RESULTS
  Among 565 patients, 255 (45%) had at least mild cognitive impairment (MoCA≤22). Death (n=43, 8%) and readmission (n=122, 21%) within 30days of discharge were more likely to occur among patients with mild cognitive impairment (OR=2.00, p=0.001). MoCA score was also negatively associated with 30-day readmission or death (OR=0.91, p<0.001) independent of other risk factors. Adding MoCA score to an existing prediction model of 30-day readmission significantly improved discrimination (C-statistic=0.715 vs. 0.617, IDI estimate 0.077, p<0.001). From prediction models developed from our study, adding MoCA score (C-statistic=0.83) provided incremental value to that of standard clinical and non-clinical factors (C-statistic=0.76) and echocardiogram parameters (C-statistic=0.81) in predicting 30-day readmission or death. Reclassification analysis suggests that addition of MoCA score improved classification for a net of 12% of patients with 30-day readmission or death and of 6% of patients without (p=0.002).
  
  
  CONCLUSIONS
  Mild cognitive impairment predicts short-term outcomes in HF, independent of clinical and non-clinical factors.
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
authors.forename: Quan L
authors.initials: QL
authors.lastname: Huynh
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Negishi
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
authors.forename: Leigh
authors.initials: L
authors.lastname: Blizzard
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
authors.forename: Makoto
authors.initials: M
authors.lastname: Saito
authors.affiliation: Cardiac Services, Flinders Medical Centre, South Australia, Australia.
authors.forename: Carmine G
authors.initials: CG
authors.lastname: De Pasquale
authors.affiliation: Baker IDI Heart and Diabetes Research Institute, Melbourne, Australia.
authors.forename: James L
authors.initials: JL
authors.lastname: Hare
authors.affiliation: Faculty of Medicine, University of New South Wales, Sydney, Australia.
authors.forename: Dominic
authors.initials: D
authors.lastname: Leung
authors.affiliation: School of Medicine, University of Queensland, Brisbane, Australia.
authors.forename: Tony
authors.initials: T
authors.lastname: Stanton
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
authors.forename: Kristy
authors.initials: K
authors.lastname: Sanderson
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
authors.forename: Alison J
authors.initials: AJ
authors.lastname: Venn
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Baker IDI Heart and Diabetes Research Institute, Melbourne, Australia. Electronic address: Tom.Marwick@bakeridi.edu.au.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Marwick
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D060825:Cognitive Dysfunction / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D004452:Echocardiography / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000523:psychology / Q000628:therapy; D006801:Humans; D007361:Intelligence Tests; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D011379:Prognosis; D012107:Research Design; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors
keywords: Cognitive function; Depression; Heart failure; Mortality; Rehospitalization