Funding Acknowledgements Type of funding sources: None. Background Cognitive impairment (CI) is common in acute coronary syndrome (ACS) patients but is often undetected and may impact recovery and secondary prevention uptake. Health professionals play a vital role in the early detection of CI through screening and managing CI in ACS patients. Purpose To explore health professionals’ knowledge, attitudes, and behaviours toward CI screening in ACS patients Methods Cardiac health professionals were recruited via acute and outpatient cardiac wards in three metropolitan teaching hospitals and from emailing members of two cardiac professional associations in Australia. All completed a 38-item survey administered in either paper or electronic format. Results 100 health professionals responded (95 nurses and five allied health workers). Respondents identified the prevalence of CI, dementia, or delirium at 25% post-ACS (50% of respondents), and 74% identified difficulties in recalling recent information as the most common indicator of CI. The cognitive screening was performed at least some of the time in ACS patients by 73%. After accounting for age, receiving training in CI, work experience, and profession, cognitive screening was conducted more than eight times more often by health professionals who work in acute settings (OR=8.78, 95%CI 2.13, 36.25) versus non-acute. Participants identified the main reasons for conducting cognitive screening as early detection of change/establishing a baseline (n=27) and when they suspected any cognitive issue or decline (n=26). The most common barriers to both screening for CI and taking further actions when CI was detected were patients being unable to communicate well (60% and 49%), patients being too unstable/unwell (59% and 42%), and the priority being the patient’s clinical care (53% and 44%). Conclusions Health professionals working in acute settings are most likely to screen for CI regardless of experience or training in CI, leaving CI likely to be undetected in ACS patients receiving care in other settings. Barriers to screening are common and challenging to address due to time shortages and the appropriateness of tools. A standardised screening guideline and more feasible screening tools are needed to overcome the barriers to cognitive screening in ACS patients. Pre-professional education should also be implemented in the future.
Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): the Vanguard Grant, Heart Foundation Background Cognitive impairment (CI) following acute coronary syndrome (ACS) is poorly understood. Purpose We aimed to explore the prevalence of CI in ACS patients four weeks post hospitalisation, the association with secondary prevention capacity and behaviours. Methods ACS inpatients who were free from visual deficits and dementia diagnoses were recruited. The post four weeks hospitalisation assessments included cognitive screening (Montreal Cognitive Assessment [MoCA], and Hopkins Verbal Learning Test [HVLT]), health literacy (Newest Vital Sign), depression (Patient Health Questionnaire-9), physical activity (Physical Activity Scale for the Elderly and Fitbit-Flex activity tracker), medication knowledge and adherence, sociodemographic and clinical factors. Results Participants (n = 45) had an average age of 65.07 ± 11.21 years, 82.2% were male, 64.4% were married/partnered and 82.2% had high school education or higher. CI occurred in 28.9% using either instrument, 20% using MoCA only and 15.6% using HVLT only. Cognitive domains affected were delayed recall (median = 5, range = 0-6) and new verbal learning and memory (15.6%). Adequate health literacy was less common in patients with CI (61.4%) than patients with normal cognition (90.3%, p = 0.024). Furthermore, patients with CI had trends for lower levels of secondary prevention capacity and behaviours, including fewer patients with high medication adherence, unlikely to be married or have an intimate partner, more depressive symptoms and lower levels of physical activity. Conclusions CI occurs in almost 30% of ACS patients four weeks post discharge, however a single screening tool is not sufficient to identify all cases. CI affected delayed recall, new verbal learning and memory; was associated with worse health literacy and may have potential implications for secondary prevention capacity.
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