急性冠脉综合征住院后当月认知功能的变化：TRACE-CORE（冠状动脉事件中的转变、风险及行动-结局研究与教育中心）的研究结果
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).
作者信息
Saczynski Jane S, McManus David D, Waring Molly E, Lessard Darleen, Anatchkova Milena D, Gurwitz Jerry H, Allison Jeroan, Ash Arlene S, McManus Richard H, Parish David C, Goldberg Robert J, Kiefe Catarina I
机构信息
From the Department of Pharmacy and Health System Sciences, Northeastern University, Boston, MA (J.S.S.); Department of Medicine (D.D.M., J.H.G.) and Department of Quantitative Health Sciences (D.D.M., M.E.W., D.L., M.D.A., J.A., A.S.A., R.H.M., R.J.G., C.I.K.), University of Massachusetts Medical School, Worcester; Evidera, Lexington, MA (M.D.A.); Meyers Primary Care Institute, Worcester, MA (J.H.G.); and Department of Medicine, Mercer School of Medicine, Macon, GA (D.C.P.).
出版信息
Circ Cardiovasc Qual Outcomes. 2017 Dec;10(12). doi: 10.1161/CIRCOUTCOMES.115.001669.
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.
背景
住院期间认知功能常受损，但出院后这种损害是缓解还是持续尚不清楚。
方法与结果
我们纳入了（2011年4月至2013年5月）1521名无痴呆的急性冠脉综合征幸存者，他们参与了TRACE（冠脉事件中的转变、风险和行动）研究，并在住院期间及出院后1个月进行了访谈。在两个时间点均使用认知状态电话访谈（范围：0 - 41）评估认知功能。患者报告了人口统计学和社会心理特征，并提取了医疗记录。使用认知状态电话访谈得分≤28作为切点，我们根据住院期间和1个月后的认知状态定义了4组认知变化：持续受损、短暂受损、新出现受损和持续未受损。使用多项逻辑回归分析与认知变化类别相关的特征。参与者中67%为男性，84%为非西班牙裔白人，平均年龄±标准差为62±11岁；16%（n = 237）在住院期间存在认知障碍，11%（n = 174）在出院后1个月存在认知障碍。总体而言，80%持续未受损，9%短暂受损，7%持续受损，4%新出现受损。较低的教育水平、少数族裔身份、低健康素养和算术能力以及较高的疾病严重程度与住院期间及出院后的认知障碍独立相关。男性与出院后认知障碍风险增加相关。
结论
急性冠脉综合征后从医院到家庭的过渡期间，男性和有社会心理脆弱性的患者认知功能变化更不理想。在医院和出院后评估认知状态对于检测那些可从包括早期随访和强化出院指导等量身定制的过渡性护理中获益的患者很重要。
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