Unrecognized Cognitive Impairment and Its Effect on Heart Failure Readmissions of Elderly Adults.
To determine whether 30-day readmissions were associated with presence of cognitive impairment more in elderly adults with heart failure (HF) than in those with other diagnoses and whether medical teams recognized cognitive impairment.



One-year prospective cohort quality improvement program of cognitive screening and retrospective chart review of documentation and outcomes.



Academic tertiary care hospital medical unit with a cardiovascular focus and an enhanced discharge program of individualized patient education.



Individuals aged 70 and older screened before home discharge (241 admission encounters; 121 with HF as a primary diagnosis, 120 without). The HF cohort included individuals with preserved and reduced ejection fraction. Individuals who had undergone transplantation, ventricular assist device implantation, or hemodialysis or who had a primary oncology diagnosis or hospice referral were excluded.



Mini-Cog administered 48 hours or less before discharge, 30-day all-cause readmission rates, documentation of dementia or cognitive impairment, and caregiver education.



Mini-Cog scores were less than 4 (indicating cognitive impairment) in 157 encounters (82 (67.7%) with HF, 75 (62.5%) without). Mini-Cog scores were similar in rate and distribution between groups. Individuals with HF and cognitive impairment had a significantly higher 30-day readmission rate than did the other groups (26.8% vs 13.2%; P = .01; HF, no cognitive impairment, 12.8%; no HF, no cognitive impairment, 13.3%; cognitive impairment, no HF, 13.3%). In individuals with HF and cognitive impairment, those with documented caregiver education had lower readmission rates than those without (14.3% vs 36.2%; P = .03). Fewer than 9% had documentation of cognitive impairment in the medical record.



Cognitive impairment, which is frequently undocumented, may indicate greater risk of readmission for individuals with HF than those without. Screening for cognitive impairment, adapting discharge for it, and involving family and caregivers in discharge education may help reduce readmissions.
Section of Geriatrics, Department of Medicine, Baylor College of Medicine, Houston, Texas.
Kathryn S
0000-0003-0812-983X
KS
Agarwal
Section of Geriatrics, Department of Medicine, Baylor College of Medicine, Houston, Texas.
Rabia
R
Kazim
Houston Methodist Research Institute, Houston, Texas.
Jiaqiong
J
Xu
School of Medicine, University of Washington, Seattle, Washington.|School of Nursing, University of Washington, Seattle, Washington.
Soo
S
Borson
Section of Geriatrics, Department of Medicine, Baylor College of Medicine, Houston, Texas.|Geriatrics Section, Department of Medicine, Houston Methodist Hospital, Houston, Texas.
George E
GE
Taffet
D000368:Aged; D000369:Aged, 80 and over; D060825:Cognitive Dysfunction / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D015577:Geriatric Assessment; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas
Mini-Cog; cognitive disorders; dementia; elderly; executive dysfunction; heart failure