Change in Cognitive Function in the Month After Hospitalization for Acute Coronary Syndromes: Findings From TRACE-CORE (Transition, Risks, and Actions in Coronary Events-Center for Outcomes Research and Education)
Department of Medicine, Division of Cardiovascular Medicine; Department of Quantitative Health Sciences; Meyers Primary Care Institute
Cardiology | Cardiovascular Diseases | Clinical Epidemiology | Epidemiology | Health Services Research
BACKGROUND: Cognitive function is often impaired during hospitalization, but whether this impairment resolves or persists after discharge is unknown.
METHODS AND RESULTS: We enrolled (April 2011-May 2013) and interviewed during hospitalization and 1-month post-discharge 1521 nondemented acute coronary syndrome survivors enrolled in TRACE (Transitions, Risks and Actions in Coronary Events). Cognitive function was assessed using the Telephone Interview of Cognitive Status (range: 0-41) at both time points. Patients reported demographic and psychosocial characteristics and medical records were abstracted. Using the Telephone Interview of Cognitive Status cut point of < /=28, we defined 4 groups of cognitive change based on cognitive status during hospitalization and 1 month later: consistently impaired, transiently impaired, newly impaired, and consistently nonimpaired. Characteristics associated with cognitive change categories were examined using multinomial logistic regression. Participants were 67% male, 84% non-Hispanic white, with mean age+/-SD 62+/-11 years; 16% (n=237) were cognitively impaired during hospitalization, and 11% (n=174) were impaired 1 month after discharge. Overall, 80% were consistently nonimpaired, 9% transiently impaired, 7% consistently impaired, and 4% newly impaired. Lower education level, minority status, low health literacy and numeracy, and higher severity of disease were independently associated with cognitive impairment during and after hospitalization. Male sex was associated with increased risk of cognitive impairment after hospital discharge.
CONCLUSIONS: Cognitive function changes during the transition from hospital to home after acute coronary syndrome are less favorable for men and those with psychosocial vulnerability. Assessing cognitive status both in hospital and post-discharge is important for detecting patients who could benefit from tailored transitional care including early follow-up and booster discharge instructions.
cognition, cognitive dysfunction, epidemiology, survivors, UMCCTS funding
DOI of Published Version
Circ Cardiovasc Qual Outcomes. 2017 Dec;10(12). pii: e001669. doi: 10.1161/CIRCOUTCOMES.115.001669. Link to article on publisher's site
Circulation. Cardiovascular quality and outcomes
Saczynski, Jane S.; McManus, David D.; Waring, Molly E.; Lessard, Darleen M.; Anatchkova, Milena D.; Gurwitz, Jerry H.; Allison, Jeroan J.; Ash, Arlene S.; McManus, Richard H.; Parish, David C.; Goldberg, Robert J.; and Kiefe, Catarina I., "Change in Cognitive Function in the Month After Hospitalization for Acute Coronary Syndromes: Findings From TRACE-CORE (Transition, Risks, and Actions in Coronary Events-Center for Outcomes Research and Education)" (2017). University of Massachusetts Medical School Faculty Publications. 1446.