Predicting non-elective hospital readmission or death using a composite assessment of cognitive and physical frailty in elderly inpatients with cardiovascular disease
Abstract Background We aimed to assess the utility of the combination of the mini-mental state examination (MMSE) + clock drawing test (CDT) and the Fried phenotype for predicting non-elective hospital readmission or death within 6 months in elderly inpatients with cardiovascular disease (CVD). Meth...
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| Format: | Article |
| Language: | English |
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BMC
2020-06-01
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| Series: | BMC Geriatrics |
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| Online Access: | http://link.springer.com/article/10.1186/s12877-020-01606-8 |
| _version_ | 1818060049541496832 |
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| author | Si-Min Yao Pei-Pei Zheng Yao-Dan Liang Yu-Hao Wan Ning Sun Yao Luo Jie-Fu Yang Hua Wang |
| author_facet | Si-Min Yao Pei-Pei Zheng Yao-Dan Liang Yu-Hao Wan Ning Sun Yao Luo Jie-Fu Yang Hua Wang |
| author_sort | Si-Min Yao |
| collection | DOAJ |
| description | Abstract Background We aimed to assess the utility of the combination of the mini-mental state examination (MMSE) + clock drawing test (CDT) and the Fried phenotype for predicting non-elective hospital readmission or death within 6 months in elderly inpatients with cardiovascular disease (CVD). Methods A single-center prospective cohort was conducted from September 2018 to February 2019. Inpatients ≥65 years old were recruited. Predictive validity was tested using a Cox proportional hazards regression model analysis, and the discriminative ability was evaluated by the receiver operating characteristic (ROC) curve. Results A total of 542 patients were included. Overall, 12% (64/542) screened positive for cognitive impairment, 16% (86/542) were physically frail and 8% (44/542) had cognitive impairment combined with physical frailty, showing an older age (P < 0.001) and a lower education level (P < 0.001) than physically frail patients. A total of 113 patients (20.9%) died or were readmitted at 6 months. Frail participants with a normal (hazard ratio [HR]: 1.73, 95% confidence interval [CI]: 1.06–2.82, P = 0.028) or impaired cognition (HR: 2.50, 95% CI: 1.27–4.91, P = 0.008) had a higher risk of non-elective hospital readmission or death than robust patients after adjusting for the age, sex, education level, marital status, the presence of diabetes mellitus, heart failure, and history of stroke. The area under the ROC curve (AUC) showed that the discriminative ability in relation to 6 months readmission and death for the MMSE + CDT + Fried phenotype was 0.65 (95% CI: 0.60–0.71), and the AUC for men was 0.71 (95% CI: 0.63–0.78), while that for women was 0.60 (95% CI: 0.51–0.69). Conclusions Accounting for cognitive impairment in the frailty phenotype may allow for the better prediction of non-elective hospital readmission or death in elderly inpatients with CVD in the short term. Trial registration ChiCTR1800017204 ; date of registration: 07/18/2018. |
| first_indexed | 2024-12-10T13:26:14Z |
| format | Article |
| id | doaj.art-cddd2178913146f4aadecc455f68574a |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-12-10T13:26:14Z |
| publishDate | 2020-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-cddd2178913146f4aadecc455f68574a2022-12-22T01:47:11ZengBMCBMC Geriatrics1471-23182020-06-0120111010.1186/s12877-020-01606-8Predicting non-elective hospital readmission or death using a composite assessment of cognitive and physical frailty in elderly inpatients with cardiovascular diseaseSi-Min Yao0Pei-Pei Zheng1Yao-Dan Liang2Yu-Hao Wan3Ning Sun4Yao Luo5Jie-Fu Yang6Hua Wang7Peking University Fifth School of Clinical MedicinePeking University Fifth School of Clinical MedicineDepartment of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencesPeking University Fifth School of Clinical MedicineDepartment of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencesDepartment of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencesPeking University Fifth School of Clinical MedicinePeking University Fifth School of Clinical MedicineAbstract Background We aimed to assess the utility of the combination of the mini-mental state examination (MMSE) + clock drawing test (CDT) and the Fried phenotype for predicting non-elective hospital readmission or death within 6 months in elderly inpatients with cardiovascular disease (CVD). Methods A single-center prospective cohort was conducted from September 2018 to February 2019. Inpatients ≥65 years old were recruited. Predictive validity was tested using a Cox proportional hazards regression model analysis, and the discriminative ability was evaluated by the receiver operating characteristic (ROC) curve. Results A total of 542 patients were included. Overall, 12% (64/542) screened positive for cognitive impairment, 16% (86/542) were physically frail and 8% (44/542) had cognitive impairment combined with physical frailty, showing an older age (P < 0.001) and a lower education level (P < 0.001) than physically frail patients. A total of 113 patients (20.9%) died or were readmitted at 6 months. Frail participants with a normal (hazard ratio [HR]: 1.73, 95% confidence interval [CI]: 1.06–2.82, P = 0.028) or impaired cognition (HR: 2.50, 95% CI: 1.27–4.91, P = 0.008) had a higher risk of non-elective hospital readmission or death than robust patients after adjusting for the age, sex, education level, marital status, the presence of diabetes mellitus, heart failure, and history of stroke. The area under the ROC curve (AUC) showed that the discriminative ability in relation to 6 months readmission and death for the MMSE + CDT + Fried phenotype was 0.65 (95% CI: 0.60–0.71), and the AUC for men was 0.71 (95% CI: 0.63–0.78), while that for women was 0.60 (95% CI: 0.51–0.69). Conclusions Accounting for cognitive impairment in the frailty phenotype may allow for the better prediction of non-elective hospital readmission or death in elderly inpatients with CVD in the short term. Trial registration ChiCTR1800017204 ; date of registration: 07/18/2018.http://link.springer.com/article/10.1186/s12877-020-01606-8Cognitive impairmentFrailtyCardiovascular diseasesNon-elective hospital readmissionElderly inpatients |
| spellingShingle | Si-Min Yao Pei-Pei Zheng Yao-Dan Liang Yu-Hao Wan Ning Sun Yao Luo Jie-Fu Yang Hua Wang Predicting non-elective hospital readmission or death using a composite assessment of cognitive and physical frailty in elderly inpatients with cardiovascular disease BMC Geriatrics Cognitive impairment Frailty Cardiovascular diseases Non-elective hospital readmission Elderly inpatients |
| title | Predicting non-elective hospital readmission or death using a composite assessment of cognitive and physical frailty in elderly inpatients with cardiovascular disease |
| title_full | Predicting non-elective hospital readmission or death using a composite assessment of cognitive and physical frailty in elderly inpatients with cardiovascular disease |
| title_fullStr | Predicting non-elective hospital readmission or death using a composite assessment of cognitive and physical frailty in elderly inpatients with cardiovascular disease |
| title_full_unstemmed | Predicting non-elective hospital readmission or death using a composite assessment of cognitive and physical frailty in elderly inpatients with cardiovascular disease |
| title_short | Predicting non-elective hospital readmission or death using a composite assessment of cognitive and physical frailty in elderly inpatients with cardiovascular disease |
| title_sort | predicting non elective hospital readmission or death using a composite assessment of cognitive and physical frailty in elderly inpatients with cardiovascular disease |
| topic | Cognitive impairment Frailty Cardiovascular diseases Non-elective hospital readmission Elderly inpatients |
| url | http://link.springer.com/article/10.1186/s12877-020-01606-8 |
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