Change in Cognitive Function in the Month After Hospitalization for Acute Coronary Syndromes: Findings From TRACE-CORE (Transition, Risks, and Actions in Coronary Events-Center for Outcomes Research and Education).
Change in Cognitive Function in the Month After Hospitalization for Acute Coronary Syndromes: Findings From TRACE-CORE (Transition, Risks, and Actions in Coronary Events-Center for Outcomes Research and Education).
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DOI：
10.1161/circoutcomes.115.001669
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发表时间：
2017-12
期刊：
影响因子：
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通讯作者：
Kiefe CI
中科院分区：
文献类型：
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作者：
Saczynski JS;McManus DD;Waring ME;Lessard D;Anatchkova MD;Gurwitz JH;Allison J;Ash AS;McManus RH;Parish DC;Goldberg RJ;Kiefe CI
认知功能在住院期间经常受到损害，但这种损害在出院后是缓解还是持续尚不清楚。我们登记了(2011年4月至2013年5月)，并在住院期间和出院后1个月采访了1521名非痴呆性急性冠脉综合征(ACS)幸存者，他们登记了冠状动脉事件中的过渡、风险和行动(TRACE)。在两个时间点使用认知状态电话访谈(TICS；范围：0~41)评估认知功能。患者报告了人口统计和心理社会特征，并提取了医疗记录。使用≤28的TICS切入点，我们根据住院期间和一个月后的认知状态定义了四组认知变化：持续性受损、一过性受损、新受损和始终如一的无受损。使用多项Logistic回归分析与认知变化类别相关的特征。受试者中67%为男性，84%为非西班牙裔白人，平均年龄为±SD62±11岁；16%(n=237)在住院期间认知受损，11%(n=174)在出院后1个月受损。总体而言，80%的人始终没有受损，9%的人是暂时性受损的，7%的人是持续性受损的，4%的人是新受损的。低教育水平、少数民族地位、低健康素养和低计算能力以及较高的疾病严重程度独立地与住院期间和住院后的认知障碍相关。男性与出院后认知障碍风险增加相关。在急性冠脉综合征从医院到家庭的过渡过程中，认知功能的变化对男性和那些有心理社会脆弱性的人不太有利。评估住院和出院后的认知状态对于检测哪些患者可以受益于量身定制的过渡性护理，包括早期随访和助推器出院指导非常重要。
Cognitive function is often impaired during hospitalization, but whether this impairment resolves or persists following discharge is unknown. We enrolled (April 2011–May 2013) and interviewed during hospitalization and 1-month post-discharge 1,521 non-demented acute coronary syndrome (ACS) survivors enrolled in the Transitions, Risks and Actions in Coronary Events (TRACE). Cognitive function was assessed using the Telephone Interview of Cognitive Status (TICS; range:0–41) at both time-points. Patients reported demographic and psychosocial characteristics and medical records were abstracted. Using a TICS cut-point of ≤28, we defined four groups of cognitive change based on cognitive status during hospitalization and one month later: consistently impaired, transiently impaired, newly impaired, and consistently non-impaired. Characteristics associated with cognitive change categories were examined using multinomial logistic regression. Participants were 67% male, 84% non-Hispanic white, with mean age ± SD 62±11 years; 16% (n=237) were cognitively impaired during hospitalization and 11% (n=174) were impaired 1-month after discharge. Overall, 80% were consistently non-impaired, 9% transiently impaired, 7% consistently impaired, and 4% newly impaired. Lower education level, minority status, low health literacy and numeracy, and higher severity of disease were independently associated with cognitive impairment during and after hospitalization. Male sex was associated with increased risk of cognitive impairment after hospital discharge. Cognitive function changes during the transition from hospital to home after ACS are less favorable for men and those with psychosocial vulnerability. Assessing cognitive status both in-hospital and post-discharge is important for detecting patients who could benefit from tailored transitional care including early follow-up and booster discharge instructions.