Document Detail

Cognitive impairment in older adults with heart failure: prevalence, documentation, and impact on outcomes.
MedLine Citation:
PMID:  23331439     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Despite the fact that 80% of patients with heart failure are aged more than 65 years, recognition of cognitive impairment by physicians in this population has received relatively little attention. The current study evaluated physician documentation (as a measure of recognition) of cognitive impairment at the time of discharge in a cohort of older adults hospitalized for heart failure.
METHODS: We performed a prospective cohort study of older adults hospitalized with a primary diagnosis of heart failure. Cognitive status was evaluated with the Folstein Mini-Mental State Examination at the time of hospitalization. A score of 21 to 24 was used to indicate mild cognitive impairment, and a score of ≤20 was used to indicate moderate to severe impairment. To evaluate physician documentation of cognitive impairment, we used a standardized form with a targeted keyword strategy to review hospital discharge summaries. We calculated the proportion of patients with cognitive impairment documented as such by physicians and compared characteristics between groups with and without documented cognitive impairment. We then analyzed the association of cognitive impairment and documentation of cognitive impairment with 6-month mortality or readmission using Cox proportional hazards regression.
RESULTS: A total of 282 patients completed the cognitive assessment. Their mean age was 80 years of age, 18.8% were nonwhite, and 53.2% were female. Cognitive impairment was present in 132 of 282 patients (46.8% overall; 25.2% mild, 21.6% moderate-severe). Among those with cognitive impairment, 30 of 132 (22.7%) were documented as such by physicians. Compared with patients whose cognitive impairment was documented by physicians, those whose impairment was not documented were younger (81.3 vs 85.2 years, P<.05) and had less severe impairment (median Mini-Mental State Examination score 22.0 vs 18.0, P<.01). After multivariable adjustment, patients whose cognitive impairment was not documented were significantly more likely to experience 6-month mortality or hospital readmission than patients without cognitive impairment.
CONCLUSIONS: Cognitive impairment is common in older adults hospitalized for heart failure, yet it is frequently not documented by physicians. Implementation of strategies to improve recognition and documentation of cognitive impairment may improve the care of these patients, particularly at the time of hospital discharge.
John A Dodson; Tuyet-Trinh N Truong; Virginia R Towle; Gerard Kerins; Sarwat I Chaudhry
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The American journal of medicine     Volume:  126     ISSN:  1555-7162     ISO Abbreviation:  Am. J. Med.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-21     Completed Date:  2013-03-12     Revised Date:  2014-04-15    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  120-6     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
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MeSH Terms
Aged, 80 and over
Cognition Disorders / complications*,  diagnosis,  epidemiology
Cohort Studies
Heart Failure / complications*
Prospective Studies
Grant Support
K23 AG030986/AG/NIA NIH HHS; K23 AG030986/AG/NIA NIH HHS; K24 AG021507/AG/NIA NIH HHS; P30 AG021342/AG/NIA NIH HHS; P30AG021342/AG/NIA NIH HHS; T32 AG019134/AG/NIA NIH HHS
Comment In:
Am J Med. 2013 Dec;126(12):e17   [PMID:  24262732 ]
Am J Med. 2013 Dec;126(12):e15   [PMID:  24262731 ]
Am J Med. 2013 Feb;126(2):93-4   [PMID:  23331431 ]
Erratum In:
Am J Med. 2013 Jun;126(6):e25

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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