Cognitive impairment, health literacy, secondary prevention capacity and behaviours in acute coronary syndrome patients at early discharge: a prospective observational study

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): the Vanguard Grant, Heart Foundation Background Cognitive impairment (CI) following acute coronary syndrome (ACS) is poorly understood. Purpose We aimed to explore the prevalence of CI in ACS patients four weeks post hospitalisation, the association with secondary prevention capacity and behaviours. Methods ACS inpatients who were free from visual deficits and dementia diagnoses were recruited. The post four weeks hospitalisation assessments included cognitive screening (Montreal Cognitive Assessment [MoCA], and Hopkins Verbal Learning Test [HVLT]), health literacy (Newest Vital Sign), depression (Patient Health Questionnaire-9), physical activity (Physical Activity Scale for the Elderly and Fitbit-Flex activity tracker), medication knowledge and adherence, sociodemographic and clinical factors. Results Participants (n = 45) had an average age of 65.07 ± 11.21 years, 82.2% were male, 64.4% were married/partnered and 82.2% had high school education or higher. CI occurred in 28.9% using either instrument, 20% using MoCA only and 15.6% using HVLT only. Cognitive domains affected were delayed recall (median = 5, range = 0-6) and new verbal learning and memory (15.6%). Adequate health literacy was less common in patients with CI (61.4%) than patients with normal cognition (90.3%, p = 0.024). Furthermore, patients with CI had trends for lower levels of secondary prevention capacity and behaviours, including fewer patients with high medication adherence, unlikely to be married or have an intimate partner, more depressive symptoms and lower levels of physical activity. Conclusions CI occurs in almost 30% of ACS patients four weeks post discharge, however a single screening tool is not sufficient to identify all cases. CI affected delayed recall, new verbal learning and memory; was associated with worse health literacy and may have potential implications for secondary prevention capacity.

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Being married/having an intimate partner/being has protective effects for mild cognitive impairment in acute coronary syndrome patients

European Heart Journal ◽

10.1093/ehjci/ehaa946.3407 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R Gallagher ◽

E Zhao ◽

S Naismith ◽

G Tofler ◽

A Bauman

Keyword(s):

Acute Coronary Syndrome ◽

Cognitive Impairment ◽

Verbal Learning ◽

Intimate Partner ◽

Funding Source ◽

Protective Effects ◽

Z Score ◽

Delayed Recall ◽

Coronary Syndrome ◽

The Mean

Abstract Background Cardiovascular disease (CVD) is a leading cause of mortality and morbidity and is known to contribute to cognitive impairment, a condition common in CVD patients. Cognitive impairment (CI) is important to detect, manage and accommodate because it limits the capacity of CVD patients to learn about secondary prevention and engage in appropriate self-care including lifestyle change. Purpose Therefore this study aimed to determine the prevalence and predictors of cognitive impairment in acute coronary syndrome (ACS) patients during hospital admission. Methods ACS (myocardial infarction, unstable angina) inpatients (n=81) who did not have a neurocognitive diagnosis were recruited to a prospective descriptive study in 2019. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA) and the Hopkins Verbal Learning Test (HVLT). Results The sample had an age mean of 63.49±10.86 (range 40–89) years, was mostly male (82.7%) and 50.6% were university educated. MI occurred in 56.8%, equally STEMI (28.4%) and nSTEMI (28.4%) with 70.4% treated by coronary intervention. The mean education adjusted MOCA score was 25.73±3.05 (range 18–31) and 48.1% were classified as having mild CI (18–26). The domain with the worst performance was delayed recall/memory domain at mean 2.58±1.77 (of potential 0–5 points). The mean unadjusted recall score on HVLT was 19.56±6.18 (range 0–32), the mean z-score −0.69±1.21 (range −4.59–1.87) and 40.7% were classified as having mild CI (age and education adjusted Z-score ≥−1). Mild CI was classified by both MOCA and HVLT (both adjusted) in 24.7%. Patients classified as having mild CI (MOCA) were significantly older (66.87 versus 60.36 years, p=0.006) and less likely and to be married or have an intimate partner (21% versus 32% p=0.039). When all factors were taken into account using multiple linear regression, higher MOCA scores in patients who were married/partnered (B=1.6) and lower scores with advancing age (B=−0.08). Conclusions Mild CI and decreased delayed recall is prevalent in ACS patients and patient education strategies need to be accommodate this. Being married/partnered may have protective effects, therefore additional support may need to be directed to single patients. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Heart Foundation of Australia Vanguard Award

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Cognitive Function and the Relationship With Health Literacy and Secondary Prevention in Patients With Acute Coronary Syndrome at Early Discharge

The Journal of Cardiovascular Nursing ◽

10.1097/jcn.0000000000000865 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Emma Zhao ◽

Nicole Lowres ◽

Sharon L. Naismith ◽

Geoffrey Tofler ◽

Adrian Bauman ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Health Literacy ◽

Cognitive Function ◽

Secondary Prevention ◽

Early Discharge ◽

Coronary Syndrome ◽

The Relationship

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Cognitive impairment and psychological state in acute coronary syndrome patients: A prospective descriptive study at cardiac rehabilitation entry, completion and follow-up

European Journal of Cardiovascular Nursing ◽

10.1177/1474515120933105 ◽

2020 ◽

pp. 147451512093310

Author(s):

Robyn Gallagher ◽

Anna Woolaston ◽

Geoffrey Tofler ◽

Adrian Bauman ◽

Emma Zhao ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cardiac Rehabilitation ◽

Processing Speed ◽

Verbal Learning ◽

Psychological State ◽

Coronary Syndrome ◽

Multiple Domain

Background Cognitive impairment may limit the uptake of secondary prevention in acute coronary syndrome patients, but is poorly understood, including in cardiac rehabilitation participants. Aim The aim of this study was to explore cognitive impairment in relation to psychological state in acute coronary syndrome patients over the course of cardiac rehabilitation and follow-up. Methods Acute coronary syndrome patients without diagnosed dementia were assessed on verbal learning, processing speed, executive function and visual attention, at cardiac rehabilitation entry, completion and follow-up and scores adjusted using normative data. The hospital anxiety and depression scale measured psychological state. Results Participants ( n = 40) had an average age of 66.2 (±8.22) years and were 70% men. Mild cognitive impairment occurred at cardiac rehabilitation entry in single 62.5% and multiple 22.5% domains but was significantly less prevalent by cardiac rehabilitation completion (52.5% and 15.0%) and follow-up (32.5% and 7.0%). Domains most often impaired were verbal learning (52.5%) and processing speed (25.6%), again decreasing significantly with time (verbal learning cardiac rehabilitation completion 42.5%, follow-up 22.5%; processing speed cardiac rehabilitation completion 15.0%, follow-up 15.0%). A small group of patients had persistent multiple domain cognitive impairment. At cardiac rehabilitation entry patients with cognitive impairment in processing speed, a single domain or multiple domains had more depression, and patients with cognitive impairment in executive function had more depression and anxiety. Conclusions At cardiac rehabilitation entry, mild cognitive impairment is very common in post-acute coronary syndrome patients and worse in patients who have depression or anxiety symptoms. Cognitive impairment decreases significantly by cardiac rehabilitation follow-up. A small proportion of patients has persistent, multiple domain cognitive impairment flagging potential long-term changes and the need for further investigations and cognitive rehabilitation.

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The impact of socioeconomic status on secondary prevention of the acute coronary syndrome

European Heart Journal ◽

10.1093/ehjci/ehaa946.2970 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Hyun ◽

D Brieger ◽

T Briffa ◽

D Chew ◽

M Horsfall ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Secondary Prevention ◽

Funding Source ◽

Post Discharge ◽

Coronary Syndrome ◽

Group 3 ◽

Group 5 ◽

Universal Health ◽

Group 1

Abstract Background Although socioeconomic status (SES) has been reported to be associated with health inequities, there are limited studies exploring the association between SES and secondary prevention of acute coronary syndrome (ACS) in countries with universal health cover. Purpose The aim is to examine whether SES has an impact on the secondary prevention of ACS in Australia. Methods Australian SNAPSHOT ACS data (2012) and its 18-month follow-up data were linked to admissions data from 6 jurisdictions covering all states and territories, national death index and Medicare Pharmaceutical Benefits Scheme data covering up to 3 years post-discharge. The five SES groups (lowest in Group 1 and highest in Group 5) were derived from the Australian Bureau of Statistics Socio-Economic Indexes for Areas (SEIFA) using the residential postcode at baseline. Outcomes were cardiac rehabilitation (CR) participation and smoking rate at 18 months post discharge as well as the use of ≥3 of the 4 indicated medications, all-cause death and cardiovascular disease (CVD) rates by 36 months of discharge. Outcomes were compared between the groups using the multilevel logistic regression with covariates of SES (5 groups), sex, GRACE risk score (4 groups), ACS diagnosis (STEMI/NSTEMI/UA) and the jurisdictions where the admissions data were linked. Results Of 1655 patients with ACS (mean age 68±13.5 yrs, 65% were male), who were discharged from hospital alive and had linked data available, 353 (21%) were in SES Group 1 (lowest SES), 369 (22%) in Group 2, 382 (23%) in Group 3, 296 (18%) in Group 4 and 255 (15%) in Group 5 (highest SES). Baseline clinical characteristics were comparable across the five SES groups. At 18-month after discharge, 1014 (61%) patients were followed-up with comparable loss to follow-up in each group. After adjustment, fewer patients in the lower SES groups (Groups 1 and 2) had participated in CR than those in the highest SES group (Group 5) (OR (95% CI): 0.60 (0.36, 0.99) and 0.56 (0.35, 0.91), respectively). Moreover, the odds of smoking was greater in Group 3 than Group 5 (2.60 (1.15, 5.89)) but no trend was found across the groups. By 36 months of discharge after adjustment, there was no difference in the odds of using ≥3 out of 4 medications between the SES groups. Despite this, patients in Groups 1 and 2 were significantly more likely to die than those in the highest SES group (1.96 (1.19, 3.21) and 1.91 (1.19, 3.07), respectively). The odds of CVD readmission did not differ across SES groups. Conclusion This study suggests that patients with low SES were less likely to participate in CR programs and more likely to die than those with high SES. Smoking rates varied between patients with intermediate and high SES but no trend was found across the groups. Despite the universal health cover available, inequity between the SES groups still exist. Future research is needed to further explore strategies to help close the evidence-practice gaps. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Australian National Heart Foundation Postdoctoral Fellowship

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Protein Intake and Physical Activity in Newly Diagnosed Patients with Acute Coronary Syndrome: A 5-Year Longitudinal Study

Nutrients ◽

10.3390/nu13020634 ◽

2021 ◽

Vol 13 (2) ◽

pp. 634 ◽

Cited By ~ 1

Author(s):

Andrea Greco ◽

Agostino Brugnera ◽

Roberta Adorni ◽

Marco D’Addario ◽

Francesco Fattirolli ◽

...

Keyword(s):

Physical Activity ◽

Acute Coronary Syndrome ◽

Protein Intake ◽

Processed Meat ◽

High Morbidity ◽

Newly Diagnosed ◽

Healthy Behaviors ◽

Coronary Syndrome ◽

Over Time

Cardiovascular disease is one of the most common causes of hospitalization and is associated with high morbidity and mortality rates. Among the most important modifiable and well-known risk factors are an unhealthy diet and sedentary lifestyle. Nevertheless, adherence to healthy lifestyle regimes is poor. The present study examined longitudinal trajectories (pre-event, 6-, 12-, 24-, 36-, and 60-month follow-ups) of protein intake (fish, legumes, red/processed meat) and physical activity in 275 newly-diagnosed patients with acute coronary syndrome. Hierarchical Generalized Linear Models were performed, controlling for demographic and clinical variables, the season in which each assessment was made, and the presence of anxiety and depressive symptoms. Significant changes in protein intake and physical activity were found from pre-event to the six-month follow-up, suggesting the adoption of healthier behaviors. However, soon after the six-month follow-up, patients experienced significant declines in their healthy behaviors. Both physical activity and red/processed meat intake were modulated by the season in which the assessments took place and by anxiety symptoms over time. The negative long-term trajectory of healthy behaviors suggests that tailored interventions are needed that sustain patients’ capabilities to self-regulate their behaviors over time and consider patient preference in function of season.

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CTNI-51. NEUROCOGNITIVE FUNCTION (NCF) OUTCOMES OF RTOG FOUNDATION 3508: A PHASE 3 TRIAL OF ABT-414 WITH CONCURRENT CHEMORADIATION AND ADJUVANT TEMOZOLOMIDE IN PATIENTS WITH EGFR-AMPLIFIED NEWLY DIAGNOSED GBM

Neuro-Oncology ◽

10.1093/neuonc/noaa215.217 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii54-ii54

Author(s):

Jeffrey S Wefel ◽

Minhee Won ◽

Andrew Lassman ◽

Yaakov Stern ◽

Tony Wang ◽

...

Keyword(s):

Learning And Memory ◽

Verbal Learning ◽

Concurrent Chemoradiation ◽

Reliable Change Index ◽

Newly Diagnosed ◽

Total Recall ◽

Phase 3 ◽

Delayed Recall ◽

Adjuvant Temozolomide ◽

Over Time

Abstract RTOG 3508/AbbVie M13-813/INTELLANCE-1 was a phase 3 trial of depatuximab-mafodotin (depatux-m, formerly ABT-414) that accrued 639 patients with EGFR-amplified newly diagnosed GBM. At the pre-specified interim OS analysis, the futility criteria were met and there was no survival benefit from adding depatux-m to SOC. Pre-specified secondary NCF analyses included time to decline in verbal learning and memory as assessed by the HVLT-R Total Recall based on the reliable change index. Exploratory NCF analyses examined changes in other HVLT-R outcomes over time. As corneal epitheliopathy causing visual impairment is a known toxicity of depatux-m, NCF tests that did not depend on visual acuity were employed. NCF testing occurred at baseline, day 1 of the first cycle of adjuvant depatux-m, every other cycle (i.e., 8 weeks) thereafter, and at progression. Compliance with test completion was 95% at screening and 80%, 70%, 58%, 51%, 47% thereafter through cycle 9. The most common reasons for missing data was site error. Time to HVLT-R Total Recall decline trended worse in the depatux-m arm compared to placebo but the difference was not significant (12 month deterioration: 41.2%, 95% CI: 3.50–47.2 vs 32.4%, 95% CI: 26.6- 38.4, p=0.052). The depatux-m arm, in comparison to the placebo arm, showed greater decline from baseline on the HVLT-R at the following time points: cycle 3 (Total Recall: mean= -1.8, SD=5.7 vs mean= -0.5, SD=5.5, respectively, p=0.046; Delayed Recall: mean= -1.1, SD=3.0 vs. mean= -0.2, SD=2.7, respectively, p=0.01), cycle 7 (Total Recall: mean= -0.6, SD=5.1 vs mean= 1.4, SD=5.0, respectively, p=0.009; Delayed Recall: mean -0.6, SD=3.0 vs. mean= 0.5, SD=2.7, respectively, p=0.01), and cycle 9 (Delayed Recall: mean=-0.4, SD=2.7 vs. mean= 0.8, SD=2.4, respectively, p=0.003). Depatux-m added to concurrent chemoradiation and adjuvant temozolomide was associated with faster time to deterioration and worse episodic learning and memory over time than placebo.

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Long-Term Prognostic Value of Cognitive Impairment on Top of Frailty in Older Adults after Acute Coronary Syndrome

Journal of Clinical Medicine ◽

10.3390/jcm10030444 ◽

2021 ◽

Vol 10 (3) ◽

pp. 444

Author(s):

Juan Sanchis ◽

Clara Bonanad ◽

Sergio García-Blas ◽

Vicent Ruiz ◽

Agustín Fernández-Cisnal ◽

...

Keyword(s):

Myocardial Infarction ◽

Older Adults ◽

Acute Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Cognitive Impairment ◽

Cognitive Function ◽

Prognostic Value ◽

Adult Survivors ◽

Prognostic Information ◽

Coronary Syndrome

Frailty is a marker of poor prognosis in older adults after acute coronary syndrome. We investigated whether cognitive impairment provides additional prognostic information. The study population consisted of a prospective cohort of 342 older (>65 years) adult survivors after acute coronary syndrome. Frailty (Fried score) and cognitive function (Pfeiffer’s Short Portable Mental Status Questionnaire—SPMSQ) were assessed at discharge. The endpoints were mortality or acute myocardial infarction at 8.7-year median follow-up. Patient distribution according to SPMSQ results was: no cognitive impairment (SPMSQ = 0 errors; n = 248, 73%), mild impairment (SPMSQ = 1–2 errors; n = 52, 15%), and moderate to severe impairment (SPMSQ ≥3 errors; n = 42, 12%). A total of 245 (72%) patients died or had an acute myocardial infarction, and 216 (63%) patients died. After adjustment for clinical data, comorbidities, and Fried score, the SPMSQ added prognostic value for death or myocardial infarction (per number of errors; HR = 1.11, 95%, CI 1.04–1.19, p = 0.002) and death (HR = 1.11, 95% 1.03–1.20, p = 0.007). An SPMSQ with ≥3 errors identified the highest risk subgroup. Geriatric conditions (SPSMQ and Fried score) explained 19% and 43% of the overall chi-square of the models for predicting death or myocardial infarction and death, respectively. Geriatric assessment after acute coronary syndrome should include both frailty and cognitive function. This is particularly important given that cognitive impairment without dementia can be subclinical and thus remain undetected.

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