UCLA

Objectives: Our objectives were to understand the patterns of cognitive and depressive change during and following a hospital admission for Acute Decompensated heart failure (ADHF) and to examine the relationship of clinical variables related to cognition over time and 30 day readmissions.

Methods: After hospital admission to a medical-surgical floor, within seven days following hospital, and after 30 days following hospital discharge, 40 patients admitted for ADHF (mean [SD] age = 73.8 [11.3] years; 72% male) completed the Montreal Cognitive Assessment (MoCA), Trail Making A & B, the Patient Health Questionnaire (PHQ)-9, and the Brief Symptom Inventory – Anxiety (BSI-A). The Medical Outcomes Study Social Support Survey (MOS-SSS) and the Self-Care Heart Failure Index (SCHFI) was completed in the hospital. Cognitive and depressive symptoms were evaluated using repeated-measures analysis of variance. Demographic and clinical variables associated with trends of cognitive and depressive symptoms were described with Kendall’s Tau correlations. Linear regressions were performed to determine if change in fluid volume status measurements were related to change of MoCA scores, controlling for demographical and clinical variables. Separate linear regressions were performed to determine if variables in the hospital were related to MoCA scores in the hospital, MoCA scores at 30 days post discharge, and the occurrence of 30 day readmissions.

Results: Neither global MoCA or TMT scores improved from hospital to 30 days post discharge. Improvement in the MoCA sub domain Visuospatial/ Executive function and depressive symptoms from hospital discharge to 30 days were observed. Four groups of MoCA change and three groups of depressive symptom change were found and associated with varied clinical and demographic variables. In multivariate analysis, only changes in weight (p=.001), HJR (p=.036), not clinical and demographical variables, were related to change of MoCA score. In multivariate analysis, only hospital variables CCI (p=.014) and anxiety (p=.005) were related to MoCA in the hospital; in a separate analysis only CCI (p=.05) remained related to MoCA post 30 days of discharge. In a fourth multivariate analysis, only CCI (p=.083) trended in association with 30 day readmission.

Conclusions: Executive function and depressive symptoms improve from hospitalization to 30 days after for ADHF. Higher anxiety symptoms and comorbidities are independently associated with worse cognition in the hospital. Findings suggest that when HF patients are in fluid overload, their cognition is worse. Clinicians should assess the patient’s cognitive, anxiety and depressive state in the hospital prior to teaching the patient as learning abilities are likely compromised. Further research is needed to explore these relationships and ultimately, to test interventions that may help HF patients with CI avoid unnecessary admissions.