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Heart. 2019 Nov;105(21):1635-1641. doi: 10.1136/heartjnl-2019-314978. Epub 2019 May 29.

Bedside mental status and outcome in elderly patients admitted for acute coronary syndromes.

Author information

1
EA4650, Normandie Université, Caen, France.
2
Department of Cardiology, Centre Hospitalier Universitaire de Caen, Caen, Basse-Normandie, France.
3
ACTION academic research group, Pitié-Salpêtrière University Hospital, Paris, France.

Abstract

OBJECTIVE:

We investigated whether mental status assessed by simple bedside tests in elderly patients admitted for acute coronary syndromes (ACS) was associated with higher risk of mortality.

METHODS:

We used the data from a prospective, open, ongoing cohort of patients≥75 years old admitted for ACS to a tertiary centre. Cognitive impairment (CogI) was defined by delirium detected by the Confusion Assessment Method or an abnormal Mini Mental State Examination score. A Cox model adjusted on predefined correlates of mortality was used to assess the relationship between CogI and 1-year mortality.

RESULTS:

Six-hundred consecutive patients with mental status assessment within 48 hours after admission were included. CogI was identified in 172 (29%) patients among whom 153 (25.5%) had an abnormal Mini Mental State Evaluation and 19 (3.2%) delirium. Death occurred in 49 (28.6%) patients with and 43 (10.5%) patients without CogI at 1 year. There was a significant association between CogI and 1-year mortality (adjusted-HR 2.4, 95% CI 1.53 to 3.62), p<0.001) independent of other covariables. CogI was also independently associated with higher rates of in-hospital bleeding and mortality as well as 3-month rates of all-cause, cardiovascular-related and heart failure-related rehospitalisation.

CONCLUSIONS:

CogI detected by simple bedside tests in patients≥75 admitted for ACS is associated with an increased risk of 1-year mortality and 3 month rehospitalisation independent of other correlates of poor outcome.

KEYWORDS:

acute coronary syndrome; cognitive impairment; death; delirium; elderly; outcome

Conflict of interest statement

Competing interests: Thelogistics and management of our cohorts are supported by grants from Biosensors, Medtronic and Boston Scientific.

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