Mini-Cog Performance

Abstract

Background— Heart failure (HF) guidelines recommend screening for cognitive impairment (CI) but do not identify how. The Mini-Cog is an ultrashort cognitive “vital signs” measure that has not been studied in patients hospitalized for HF. The purpose of this study was to evaluate whether CI as assessed by the Mini-Cog is associated with increased readmission or mortality risk after hospitalization for HF. Methods and Results— We analyzed 720 consecutive patients who completed the Mini-Cog as a part of routine clinical care during hospitalization for HF. Our primary outcome was time between hospital discharge and first occurrence of readmission or mortality. There was a high prevalence of CI as quantified by Mini-Cog performance (23% of cohort). During a mean follow-up time of 6 months, 342 (48%) patients were readmitted, and 24 (3%) died. Poor Mini-Cog performance was an independent predictor of composite outcome (adjusted hazard ratio, 1.90; 95% confidence interval, 1.47–2.44; P <0.0001) and was identified as the most important predictor among 55 variables by random survival forest analysis. Inclusion of Mini-Cog performance in risk models improved accuracy (bootstrapped c -index, 0.602 versus 0.624) and risk reclassification (category-free net reclassification improvement, 27%; 95% confidence interval, 14%–40%; P <0.001). Secondary analysis of initial 30 days post discharge showed effect modification by venue of discharge, whereby patients with CI discharged to a facility had longer time to outcome as compared with those discharged home. Conclusions— Mini-Cog performance is a novel marker of posthospitalization risk. Discharge to facility rather than home may be protective for those patients with HF and CI. It is unknown whether structured in-home support would yield similar outcomes.

Medication self-management skills and cognitive impairment in older adults hospitalized for heart failure: A cross-sectional study

“…1,23 We scored this test on a 5-point scale (1 point for each correct word recalled and 2 points for correct clock drawing), with a score of ≤2 defining presence of CgI. 23 We chose this instrument because of its brevity, speed of application (on average, it takes approximately 3 min to complete), and prior literature describing its utility in patients hospitalized for HF.…”

The Prevention of Hospital Readmissions in Heart Failure

“…11,12 Poor performance on the Mini-Cog exam was recently found to be both prevalent in a quarter of HF patients and doubled the risk of death or readmission during a mean follow-up of 6 months. 13 Evaluation of health literacy, functional and cognitive status along with traditional markers of HF severity would strengthen models, but further validation is required.…”

What to Expect From the Evolving Field of Geriatric Cardiology

“…Presence of cognitive impairment and frailty in a patient with HF will, for example, significantly increase the risk of hospital admissions, disability, procedural complications and mortality (27). At the center of this is the understanding that for a patient who has already reached his or her anticipated life expectancy, the relevance and utility of predicting 10 year mortality may have less priority than predicting future quality of life and the likelihood of maintaining independence.…”