Hiroshi Saito1, Masashi Yamashita2, Yoshiko Endo3, Akira Mizukami4, Kenji Yoshioka4, Tomoaki Hashimoto5, Shoko Koseki6, Yu Shimode7, Takeshi Kitai8, Emi Maekawa9, Takatoshi Kasai10, Kentaro Kamiya11, Yuya Matsue12. 1. Department of Rehabilitation, Kameda Medical Center, Chiba, Japan; Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan. 2. Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan. 3. Department of Rehabilitation, Kameda Medical Center, Chiba, Japan. 4. Department of Cardiology, Kameda Medical Center, Chiba, Japan. 5. Department of Pharmacy, Kameda Medical Center, Chiba, Japan. 6. Department of Rehabilitation, Kitasato University Hospital, Kanagawa, Japan. 7. Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan. 8. Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan; Department of Clinical Research Support, Kobe City Medical Center General Hospital, Kobe, Japan. 9. Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan. 10. Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan. 11. Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan. Electronic address: k-kamiya@kitasato-u.ac.jp. 12. Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan. Electronic address: yuya8950@gmail.com.
Abstract
BACKGROUND: There has been no study elucidating whether cognitive impairment (CI) can provide additive prognostic information besides that provided by preexisting prognostic factors in elderly patients with heart failure. This study examined whether CI can provide additive prognostic information in elderly patients with heart failure. METHODS: This multicenter retrospective study included 352 patients with heart failure aged ≥75 years. We administered the Mini-Mental State Examination (MMSE) and Mini-Cog test to assess CI. The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score was used as a model to incorporate the preexisting prognostic factors. All-cause mortality was considered the prognostic outcome. RESULTS: The median age was 85 years old, 47.7% were male. According to MMSE and Mini-Cog, 167 (47.4%) and 159 (45.2%) patients had CI, respectively. The agreement between MMSE and Mini-Cog was fairly low (Cohen's kappa coefficient 0.37). During the follow-up period of median 346 days, 53 patients (15.1%) died. In multivariate Cox regression analysis, CI defined by MMSE and Mini-cog were individually associated with worse prognosis in older heart failure patients even after adjustment for MAGGIC risk model and log B-type natriuretic peptide levels [CI defined by MMSE, HR: 2.05 (95%CI: 1.16-3.61); and CI defined by Mini-Cog, HR:2.57 (95%CI: 1.46-4.53)]. The area under the curve of receiver operator characteristics curve was numerically greater for Mini-Cog than for MMSE (0.59 vs. 0.52, p = 0.109). Moreover, significant net reclassification improvement was observed when CI defined by Mini-Cog, but not on CI defined by MMSE, was added to the MAGGIC score, and when Mini-Cog, instead of MMSE, was used as a CI assessment tool (0.41, p = 0.004). CONCLUSIONS: Among elderly hospitalized patients with heart failure, CI should be considered as a critical factor for prognosis prediction. Mini-Cog is a potentially preferable tool to assess CI in terms of providing prognostically relevant information compared to MMSE.
BACKGROUND: There has been no study elucidating whether cognitive impairment (CI) can provide additive prognostic information besides that provided by preexisting prognostic factors in elderly patients with heart failure. This study examined whether CI can provide additive prognostic information in elderly patients with heart failure. METHODS: This multicenter retrospective study included 352 patients with heart failure aged ≥75 years. We administered the Mini-Mental State Examination (MMSE) and Mini-Cog test to assess CI. The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score was used as a model to incorporate the preexisting prognostic factors. All-cause mortality was considered the prognostic outcome. RESULTS: The median age was 85 years old, 47.7% were male. According to MMSE and Mini-Cog, 167 (47.4%) and 159 (45.2%) patients had CI, respectively. The agreement between MMSE and Mini-Cog was fairly low (Cohen's kappa coefficient 0.37). During the follow-up period of median 346 days, 53 patients (15.1%) died. In multivariate Cox regression analysis, CI defined by MMSE and Mini-cog were individually associated with worse prognosis in older heart failurepatients even after adjustment for MAGGIC risk model and log B-type natriuretic peptide levels [CI defined by MMSE, HR: 2.05 (95%CI: 1.16-3.61); and CI defined by Mini-Cog, HR:2.57 (95%CI: 1.46-4.53)]. The area under the curve of receiver operator characteristics curve was numerically greater for Mini-Cog than for MMSE (0.59 vs. 0.52, p = 0.109). Moreover, significant net reclassification improvement was observed when CI defined by Mini-Cog, but not on CI defined by MMSE, was added to the MAGGIC score, and when Mini-Cog, instead of MMSE, was used as a CI assessment tool (0.41, p = 0.004). CONCLUSIONS: Among elderly hospitalized patients with heart failure, CI should be considered as a critical factor for prognosis prediction. Mini-Cog is a potentially preferable tool to assess CI in terms of providing prognostically relevant information compared to MMSE.