Cognitive impairment confers poor outcomes in older patients with ACS
Patients with ACS aged at least 75 years with cognitive impairment had elevated risk for mortality and rehospitalization after 3 months, according to findings published in Heart.
Clément Briet, MD, and colleagues investigated whether mental status assessed by simple bedside tests in elderly patients admitted for ACS was associated with elevated risk for mortality.
“Despite the high likelihood of mental state impairment among the constantly growing group of elderly patients admitted for ACS, there is a lack of data on such association and its detrimental effect on outcome and an urgent need to fill this gap,” Briet, of Normandy University in France, and colleagues wrote.
The researchers analyzed data from a prospective, open, ongoing cohort of patients aged at least 75 years admitted to a tertiary center for ACS. Cognitive impairment was defined by delirium as detected by the Confusion Assessment Method or an abnormal Mini-Mental State Examination score.
The primary outcome was mortality at 1 year.
In 600 consecutive patients with mental status assessment within 48 hours of admission between November 2012 and January 2017 (mean age, 82 years; 56% men), Briet and colleagues identified that 29% had cognitive impairment. Of the patients with cognitive impairment, 153 had an abnormal Mini-Mental State Evaluation and 19 had delirium.
Mortality at 1 year occurred in 28.6% patients with cognitive impairment and 10.5% of patients without it, the researchers wrote.
Briet and colleagues determined a significant association between cognitive impairment and 1-year mortality independent of other covariables (adjusted HR = 2.4; 95% CI, 1.53-3.62).
The researchers discerned that cognitive impairment was independently associated with increased rates of in-hospital bleeding and mortality as well as 3-month rates of all-cause, CV-related and HF-related rehospitalization.
“This simple assessment of mental status early after admission allows further identification of patients at higher risk in an already high-risk population,” Briet and colleagues wrote. “Our results warrant further studies to assess whether these tests detect subclinical dementia in the setting of ACS and if a specific management of such patients may reduce mortality.” – by Earl Holland Jr.
Disclosures: The authors report no relevant financial disclosures.