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Mini-Cog test predicted 30-day outcomes for patients with HF
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WASHINGTON — Poor performance on the Mini-Cog test was associated with increased risk for death or hospital readmission within 30 days after discharge among older patients with HF, researchers reported at the American College of Cardiology Scientific Sessions.
In the Mini-Cog test, subjects are provided three consecutive words, then are asked to draw a clock showing the time of 8:20, then are asked to repeat the three words in exact order, Eiran Gorodeski, MD, MPH, from Cleveland Clinic, explained at a press conference. Participants are given two points for drawing the clock correctly and one point for each word remembered correctly in the correct order. A score of 0 to 2 indicates a high likelihood of cognitive impairment and a score of 3 to 5 indicates a low likelihood of cognitive impairment, he said.
The researchers performed a single-center study of 720 patients aged 65 years and older (mean age, 77 years; 76% white; 57% men) hospitalized for HF between July 2012 and July 2013. The primary endpoint was freedom from 30-day readmission or mortality.
Eiran Gorodeski
Twenty-three percent of those enrolled scored 2 or less on the Mini-Cog test. A lower score was reported more frequently in women (P=.02) and black participants (P<.01), according to the researchers.
At 30 days, 47% of those who scored 2 or less on the Mini-Cog died or were readmitted, compared with 22% of those who scored 3 or more (P<.001). “This outcome was almost entirely driven by readmissions,” Gorodeski said.
Notably, he said, results for those who scored 2 or less differed based on whether they were discharged home or to a nursing facility, as at 30-days post-discharge, 51% of those discharged home met the primary endpoint vs. 40% of those discharged to a facility. There was no difference by discharge destination for those who scored 3 or more.
Further, patients who performed poorly on the Mini-Cog and were discharged to a facility saw a significant delay in the mean time before their first readmission event or death (21 days vs. 2 days), Gorodeski said.
“This suggests that going to a highly structured, community-based [destination] such as a nursing facility may modify or delay the deleterious impact of cognitive impairment on outcomes,” Gorodeski said.
“Screening for cognitive impairment is simple; it takes less than 3 minutes to complete and does not require nurses who do it to have any research training,” he said. – by Erik Swain
For more information:
Gorodeski E. Abstract #913-6. Presented at: American College of Cardiology Scientific Sessions; March 29-31, 2014; Washington, D.C.
Disclosure: Gorodeski reports no relevant financial disclosures.
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Mary Norine Walsh, MD, FACC
This is huge. Some of the scores that have been used already for predicting outcomes in HF patients include a lot of different measures and have included a little bit of cognition, but not to the point that Gorodeski and colleagues have. One-fourth of their patients had cognitive impairment. Clearly, it should be a target for the future to improve the cognition or identify those patients and address that need, because if they’re the patients at higher risk, they may need a different care environment after discharge.
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