Mini-Cog provides valuable prognostic data in elderly heart failure patients

Cognitive impairment (CI) is an important prognostic factor among elderly patients hospitalized with heart failure, a recent study has shown. The Mini-Cog tool provides useful information in this population.

Researchers conducted a multicentre retrospective study on 352 older adults (median age, 85 years; 47.7 percent male) with heart failure. CI was assessed using the Mini-Mental State Examination (MMSE) and the Mini-Cog. Other existing and known prognostic factors were incorporated using the model Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score.

Nearly half of the enrolled participants had CI, as determined by both the MMSE (47.4 percent) or the Mini-Cog (49.4 percent). These patients tended to be female, older, and have lower heart rates.

Patients were followed for a median of 346 days, during which 53 died, yielding a mortality rate of 15.1 percent. Kaplan-Meier curves showed that mortality was higher among patients who had CI according to the Mini-Cog (p=0.005). This was not true when CI was assessed using the MMSE (p=0.059).

Multivariate Cox regression analysis, adjusted for both the MAGGIC score and levels B-type natriuretic peptide, showed that CI based on both the Mini-Cog (hazard ratio [HR], 2.49, 95 percent confidence interval [CI], 1.10–4.43; p=0.002) and the MMSE (HR, 2.05, 95 percent CI, 1.16–3.61; p=0.013) were significantly predictive of all-cause death.

Incorporating MMSE- or Mini-Cog-assessed CI into the MAGGIC score led to areas under the curve that were nonsignificantly different from each other, although only the inclusion of the Mini-Cog led to a statistically significant net reclassification improvement (p=0.004).

“Mini-Cog is a practical tool to assess CI in daily clinical practice and is capable of providing additive prognostic information in addition to known prognostic factors,” the researchers said. “Whether prognosis can be improved by providing targeted intervention to this population should be tested in a future randomized control trial.”