BackgroundCognitive impairment is a prevalent, independent marker of readmission in heart failure (HF), but the screening is time-consuming. This study sought (1) to identify HF patients at low risk of cognitive impairment (obviating screening) and (2) to simplify a predictive model of HF outcomes by only using cognitive domains that are most predictive.Methods and ResultsThe Montreal Cognitive Assessment was performed in 1152 Australian patients with HF who were followed for 12 months. One-third (376/1152) of the patients were enrolled into an HF disease management plan to reduce early readmission. Postdischarge outcomes in HF included 30- and 90-day readmission or death and days alive and out of hospital within 12 months of discharge. Cognitive impairment—present in 54% of patients—independently predicted HF outcomes. Normal cognition could be predicted with common clinical and sociodemographic factors with good discrimination (C statistic=0.74 [0.69–0.78]). The visuospatial/executive and orientation domains were most predictive of HF postdischarge outcomes. Using either Montreal Cognitive Assessment score or these 2 domains provided similar incremental values (P=0.0004 and P=0.0008, respectively) in predicting HF outcomes (both C statistic=0.76) and could similarly identify a group of high-risk patients who benefited most from an HF disease management plan.ConclusionsCognitive function independently predicts HF outcomes and may also contribute to how a patient responds to intervention. The time and resources spent on cognitive assessment for risk-stratification in HF may be minimized by (1) identifying patients with low risk of cognitive impairment and (2) simplifying the screening instrument to include only the domains that are most predictive of postdischarge outcomes in HF.

中文翻译：

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住院心力衰竭患者的认知领域和出院后结果

背景认知障碍是心力衰竭（HF）再入院的普遍，独立标志，但筛查非常耗时。这项研究试图（1）识别具有低认知障碍风险（避免筛查）的HF患者，以及（2）仅通过使用最具预测性的认知领域来简化HF结果的预测模型。在1152名澳大利亚心衰患者中随访了12个月。三分之一（376/1152）的患者参加了HF疾病管理计划，以减少早期再入院。HF的出院后结局包括30天和90天的再入院或死亡，以及出院后12个月内仍存活和住院的天数。认知障碍（占54％的患者）独立预测心衰结果。可以通过常见的临床和社会人口统计学因素并具有良好的辨别力来预测正常认知（C统计量= 0.74 [0.69–0.78]）。视觉空间/执行和方向域最能预测出院后HF的结果。使用蒙特利尔认知评估得分或这两个域提供相似的增量值（在预测HF结果时（P分别为P = 0.0004和P = 0.0008）（C统计量均为0.76），并且可以类似地识别出一组从HF疾病管理计划中受益最大的高风险患者。结论认知功能独立地预测HF的结果并且可能也有助于患者对干预的反应。通过（1）识别认知障碍风险低的患者，以及（2）简化筛查工具，使其仅包括最能预测出院后结局的领域，可以最大程度地减少用于心力衰竭风险分层的认知评估所花费的时间和资源。高频