Cognitive impairment as a determinant of response to management plans after heart failure admission
Cognitive impairment as a determinant of response to management plans after heart failure admission
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DOI：
10.1002/ejhf.2177
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发表时间：
2021-04-19
影响因子：
18.2
通讯作者：
Marwick, Thomas H.
中科院分区：
文献类型：
--
作者：
Huynh, Quan L.;Whitmore, Kristyn;Marwick, Thomas H.
认知功能障碍（CI）在心力衰竭（HF）患者中非常普遍，并增加了患者再次入院的风险。本研究旨在确定CI的存在和程度是否可以确定患者最有可能从HF疾病管理计划（HF）中受益，以减少再入院率。方法和结果共1152例连续入院的澳大利亚HF患者（2014-2017）进行了前瞻性随访12个月。其中，324例接受了随访（持续时间1个月，包括出院后家访、药物核对、运动指导和早期临床审查）的患者与648例常规护理患者相匹配（比例为1：2）。在出院当天或出院前一天使用蒙特利尔认知评估（莫卡）评估认知功能。结果包括1个月、3个月和12个月时的再入院或死亡，以及出院后12个月内的在家天数。术后认知功能与所有不良结局相关。与常规治疗相比，与HF治疗无关，接受HF治疗的患者30天[比值比（OR）0.60，95%置信区间0.40，0.91]和90天（OR 0.53，95%置信区间0.36，0.77）再入院或死亡的几率较低，12个月内在家的天数多19天。认知功能减退患者的这些关联效应量大于认知功能正常患者（交互作用P = 0.036），与更严重的CI患者相比，轻度CI患者中可能更明显（莫卡评分17-22; OR 0.42，95%置信区间0.21，0.87）（90天时OR 0.31，95%置信区间0.16，0.60）。认知功能正常的患者发生事件较少，无论是否发生脑卒中。结论认知功能可能决定HF患者对脑卒中的反应。在实施认知功能检查之前进行认知功能检查，可以为具有不同认知功能水平的患者提供个性化计划。
Aims Cognitive impairment (CI) is highly prevalent in heart failure (HF), and increases patients' risks of readmission. This study sought to determine whether the presence and degree of CI could identify patients most likely to benefit from a HF disease management programme (DMP) to reduce readmissions.Methods and results A total of 1152 consecutive Australian patients admitted with HF (2014-2017) were prospectively followed up for 12 months. Of these, 324 patients who received DMP (1-month duration, including post-discharge home visits, medication reconciliation, exercise guidance and early clinical review) were matched (1:2 ratio) with 648 usual care patients. Cognitive function was assessed either on the day of or one day before discharge using the Montreal Cognitive Assessment (MoCA). Outcomes included readmission or death at 1, 3 and 12 months, and days at home within 12 months of discharge. Poorer cognitive function was associated with all adverse outcomes. Compared with usual care, DMP was associated with lower odds of 30-day [odds ratio (OR) 0.60, 95% confidence interval 0.40, 0.91] and 90-day (OR 0.53, 95% confidence interval 0.36, 0.77) readmission or death, and with 19 more days at home within 12 months, independent of HF therapy. The effect sizes of these associations were greater for patients with diminished cognition than those with normal cognition (interaction P = 0.036), and might have been more pronounced among those with mild CI compared with those with more severe CI (MoCA score 17-22; OR 0.42, 95% confidence interval 0.21, 0.87) at 30 days (OR 0.31, 95% confidence interval 0.16, 0.60 at 90 days). Patients with normal cognition had fewer events, irrespective of DMP.Conclusions Cognitive function may determine how HF patients respond to a DMP. Cognitive screening before implementation of a DMP may allow personalized plans for patients with different levels of cognitive function.