Abstract 329: Change in Cognitive Status in the Month Following Hospitalization for an Acute Coronary Syndrome: findings from TRACE-CORE
Background: Cognitive impairment (CI) during hospitalization is associated with poor long-term outcomes but little is known about changes in cognitive status soon after discharge.
Methods: Adults (n=1,545) without dementia or delirium were interviewed during hospitalization for an Acute Coronary Syndrome (ACS) and at 1-month post-discharge as part of the ongoing Transitions, Risks and Actions in Coronary Events - Center for Cardiovascular Outcomes Research and Education (TRACE-CORE) study. CI was indicated by a score ≤28 on the Telephone Interview of Cognitive Status (TICS; range: 0-41). Patients reported demographic characteristics, anxiety (GAD7), depression (PHQ9), and stress (PSS4). Factors associated with cognitive change categories (consistently impaired, transiently impaired, newly impaired versus not impaired) were examined using adjusted multinomial logistic regression (Table).
Results: Participants were 66% male, 83% non-Hispanic white, and aged 62±11 years. Of those with CI during hospitalization (16%; n=245), 53% remediated by 1-month. Among the remaining 1300 patients, with normal cognitive function during hospitalization, 5% (n=67) had developed cognitive impairment by 1-month post discharge. Women had higher odds of becoming newly impaired (Table). Low education, health literacy, and numeracy were associated with persistent, transient, and new impairment. Compared to those who lived with a spouse, patients who lived alone were more likely to be transiently impaired, and those who lived with others were more like to become newly impaired. High stress and low social support were associated with persistent impairment.
Conclusions: For many patients with ACS, cognitive status changes during the transition from hospital to home; thus, assessing cognition both in-hospital and post-discharge is important for detecting patients who could benefit from tailored transitional care, because they are at high risk for decline, or early follow-up for booster discharge instructions and secondary prevention, because there is a good chance of their improving.
Author Disclosures: J.S. Saczynski: None. M.E. Waring: None. D.D. McManus: None. M. Anatchkova: None. R. McManus: None. D. Parish: None. J.H. Gurwitz: None. R.J. Goldberg: None. J.J. Allison: None. A.S. Ash: None. C.I. Kiefe: None.
- © 2014 by American Heart Association, Inc.