Predicting Non-elective hospital readmission or Death using a Composite Assessment of Cognitive and Physical Frailty in Elderly inpatients with Cardiovascular Disease

Abstract

Background: We aimed to assess the utility of the combination of the mini-mental state examination (MMSE) + clock drawing test (CDT) and the Fried phenotype for predicting non-elective hospital readmission or death within six months in elderly inpatients with cardiovascular disease (CVD).Methods: A single-center prospective cohort was conducted from September 2018 to February 2019. Inpatients ≥65 years old were recruited. Predictive validity was tested using a Cox proportional hazards regression model analysis, and the discriminative ability was evaluated by the receiver operating characteristic (ROC) curve. Results: A total of 542 patients were included. Overall, 12% (64/542) screened positive for cognitive impairment, 16% (86/542) were physically frail and 8% (44/542) had cognitive impairment combined with physical frailty, showing an older age (P<0.001) and a lower education level (P<0.001) than physically frail patients. A total of 113 patients (20.9%) died or were readmitted at six months. Frail participants with a normal (hazard ratio [HR]: 1.73, 95% confidence interval [CI]: 1.06-2.82, P=0.028) or impaired cognition (HR: 2.50, 95% CI: 1.27-4.91, P=0.008) had a higher risk of non-elective hospital readmission or death than robust patients after adjusting for the age, sex, education level, marital status, the presence of diabetes mellitus, heart failure, and history of stroke. The area under the ROC curve (AUC) showed that the discriminative ability in relation to six months readmission and death for the MMSE + CDT + Fried phenotype was 0.65 (95% CI: 0.60-0.71), and the AUC for men was 0.71 (95% CI: 0.63-0.78), while that for women was 0.60 (95% CI: 0.51-0.69).Conclusions: Accounting for cognitive impairment in the frailty phenotype may allow for the better prediction of non-elective hospital readmission or death in elderly inpatients with CVD in the short term.Trial registration: ChiCTR1800017204; date of registration: 07/18/2018.

Prevalence and prognostic impact of cognitive frailty in elderly patients with heart failure: sub‐analysis of FRAGILE‐HF

“…29 Unfortunately, only a few studies with very limited number of patients have investigated the prognostic impact of cognitive frailty in patients with HF. 12,26,30 One of the strengths of our study is that we were able to demonstrate the prevalence and prognostic impact of cognitive frailty in a sufficient number of patients and events, which allows for a reliable analysis regarding the association between cognitive frailty and poor prognosis independent of other potential prognostic factors. Moreover, we demonstrated that the negative prognostic impact of cognitive frailty remained constant regardless of the tool used to define physical frailty.…”

“…A sub-analysis of HF only among patients with coronary artery disease (n = 66) showed that 15.2% of patients had cognitive frailty. 26 A previous study investigating the impact of concurrent grip weakness and cognitive impairment on prognosis in elderly patients with HF (n = 56) found that 9% of patients had combined grip weakness and cognitive impairment. 28 Regarding the prognostic impact of cognitive frailty, the results of the aforementioned three-city study in France showed that cognitive frailty was associated with a 1.9-fold Adjusted for age; male gender; body mass index; estimated glomerular filtration rate; New York Heart Association III/IV; systolic blood pressure; left ventricular ejection fraction; history of atrial fibrillation, coronary artery disease, diabetes mellitus, chronic obstructive pulmonary disease, heart failure, and hypertension; smoking status; albumin, haemoglobin, sodium level, and log-transformed BNP at discharge; and prescription of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, beta-blocker, and mineralocorticoid receptor antagonist at discharge.…”

“…25 Another cohort study of 542 patients with lifestyle-related diseases showed that 8% had cognitive frailty, with the prevalence increasing with age. 26 Moreover, a French three-city study that evaluated more than 6000 community-dwelling older adults found that 7% of the total population were diagnosed as frail using the Fried criteria and that 22% of the frail population (i.e. 1.5% of the total cohort) were also complicated with cognitive impairment assessed using the Mini-Mental State Examination.…”

“…Indeed, a cohort study in Singapore that evaluated 5414 community‐dwelling older Singaporeans showed a 1.6% prevalence of cognitive frailty 25 . Another cohort study of 542 patients with lifestyle‐related diseases showed that 8% had cognitive frailty, with the prevalence increasing with age 26 . Moreover, a French three‐city study that evaluated more than 6000 community‐dwelling older adults found that 7% of the total population were diagnosed as frail using the Fried criteria and that 22% of the frail population (i.e.…”

“…In contrast, only a few studies have evaluated the prevalence of cognitive frailty in patients with HF. A sub‐analysis of HF only among patients with coronary artery disease ( n = 66) showed that 15.2% of patients had cognitive frailty 26 . A previous study investigating the impact of concurrent grip weakness and cognitive impairment on prognosis in elderly patients with HF ( n = 56) found that 9% of patients had combined grip weakness and cognitive impairment 28 …”