Abstract
Background/Aims Cognitive impairment (CI) among hospitalized patients is associated with lack of functional recovery, rehospitalization, and death, but limited data exist on cognitive function in patients hospitalized for acute coronary syndromes (ACS). We examine in-hospital clinical and treatment factors associated with cognitive function among patients with an ACS.
Methods Adults (n = 1730 to date) in central MA, Atlanta, GA, and Macon, GA, without dementia or delirium, were interviewed during hospitalization for an ACS as part of an ongoing study within the Transitions, Risk, and Actions in Coronary Events: Center for Outcomes Research and Education (TRACE-CORE). Cognitive function was assessed by the Telephone Interview of Cognitive Status (TICS; range = 0–41; impaired = 31 or less). Medical record review (n = 111 to date with full data expected in winter, 2013) was used to abstract baseline characteristics, in-hospital treatment, and in-hospital outcomes. Linear regression analysis examined patient demographics, medical history, key laboratory and treatment characteristics in relation to in-hospital cognitive status.
Results Participants were 63% (70 of 111) male, 90% (100 of 111) non-Hispanic white and aged 63.3±12.3 years. The average TICS score was 32.7 ±3 and 23% (26 of 111) were cognitively impaired. In general, patients with CI were only mildly impaired (mean TICS = 28.7). Older age, a history of coronary heart disease and higher maximum troponin I levels during hospitalization for an ACS were associated with significantly lower in-hospital cognitive function (all P’s <0.05). There was a trend for lower cognitive function among patients who had undergone CABG (P = 0.09). Discharge to a nursing facility was also associated with significantly poorer in-hospital cognitive function (P <0.001).
Conclusions Medical history and in-hospital clinical factors are associated with cognitive status during hospitalization for ACS. Screening for CI, which is common among patients hospitalized for ACS, would identify patients who may require tailored transitional care or closer post-discharge monitoring. Future work in this study will examine which clinical characteristics are associated with transient (in-hospital only) as compared with longer-term cognitive dysfunction.
