Abstract 11035: Impact of Cognitive Impairment on 30-Day Heart Failure Readmission Among Older Adults
BACKGROUND: In the US, heart failure has the highest total care cost to healthcare system with 6 months readmission rate of up to 44%. A strong association exists between 6-month readmission for heart failure and cognitive impairment. In 2012, Medicare adopted 30-day readmission for heart failure as one of the quality measure to assess hospitals’ readmission performance. We seek to determine whether cognitive impairment played a role in 30-day heart failure readmission.
METHODS: This is a prospective study of 133 patients aged ≥65 years admitted with heart failure. We administered a brief cognitive test (CLOX) close to discharge. The patients were classified as cognitively impaired (n=90) or non-cognitively impaired (n=43) based on their CLOX score and followed for 30 days. The main outcome measure was readmission within 30 days of discharge. Readmission percentages of the two groups were compared using Fisher exact test as well as for these groups within discharge destinations. Cox regression was used to compare the probability of readmission for the two groups after adjustment for covariates (age, sex, race, discharge disposition, comorbidities, and number of discharge medications).
RESULTS: At 30 days,there was no significant difference in all-cause readmission rates between the cognitively impaired group (23.3%) and the non-cognitively impaired group (25.6%), [p=0.8296]. There was also no significant difference in heart failure specific readmission rates between the two groups (11.1% vs 7% respectively, p=0.5469]. Discharge destination did not significantly impact readmission rates between the two groups although the cognitively impaired who were discharged home tended to be readmitted more frequently. After adjusting for covariates, there was no significant difference in all-cause readmission rates [p=0.546] and in heart failure specific readmission [p=0.5270] rates between the two groups. Notably, a large number of patients with cognitive impairment were unrecognized by physicians (CLOX vs. documented dementia: 67.7% vs. 11.3%)
CONCLUSION: Although cognitively impaired patients that were discharged home were readmitted at a higher rate, cognitive impairment did not significantly impact 30-day readmission for heart failure patients.
Author Disclosures: C. Ugwummadu: None. K. Duffy: None. A. Bekui: None. M. Trentalange: Other Research Support; Modest; Yale Claude D. Pepper Older Americans Independence Center (P30 AG021342). T. Donohue: None. G. Kerins: None.
- © 2014 by American Heart Association, Inc.