Effects of Cumulative Cognitive Function Within 1 Year of Discharge on Subsequent Mortality Among Patients Hospitalized for Acute Heart Failure: A Nationwide Prospective Cohort Study

Abstract

Abstract Background To examine the association between cumulative cognitive function and subsequent mortality among patients hospitalized for acute heart failure (AHF). Methods Based on a prospective cohort of patients hospitalized for AHF, cognitive function was measured using Mini-Cog test at admission, 1- and 12-month following discharge. Cumulative cognitive function was interpreted by cumulative Mini-Cog score and cumulative times of cognitive impairment. Outcomes included subsequent all-cause and cardiovascular mortality. Results 1 454 patients hospitalized for AHF with median follow-up of 4.76 (interquartile range [IQR]: 4.18–5.07) years were included. Tertile 1 of cumulative Mini-Cog score had the highest risk of all-cause (hazard ratio [HR]: 1.52, 95% confidence interval [CI]: 1.14–2.03) and cardiovascular mortality (HR: 1.40, 95% CI: 1.02–1.93) compared with Tertile 3; patients with ≥2 times of cognitive impairment had the highest risk of all-cause (HR: 1.34, 95% CI: 1.03–1.73) and cardiovascular mortality (HR: 1.25, 95% CI: 0.93–1.67) compared with patients without any cognitive impairment. Cumulative Mini-Cog score provided the highest incremental prognostic ability in predicting all-cause (C-statistics: 0.64, 95% CI: 0.61–0.66) and cardiovascular mortality (C-statistics: 0.63, 95% CI: 0.60–0.67) risk on the basis of Get With The Guidelines-Heart Failure score. Conclusions Poor cumulative cognitive function was associated with increased risk of subsequent mortality and provided incremental prognostic ability for the outcomes among patients with AHF. Longitudinal assessment and monitoring of cognitive function among patients with AHF would be of great importance in identifying patients at greater risk of self-care absence for optimizing personal disease management in clinical practice.