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

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


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.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / diagnosis*
  • Acute Coronary Syndrome / mortality
  • Acute Coronary Syndrome / psychology
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cognition Disorders / diagnosis*
  • Cognition Disorders / mortality
  • Cognition Disorders / psychology
  • Cognition*
  • Female
  • Geriatric Assessment*
  • Humans
  • Male
  • Mental Health
  • Mental Status and Dementia Tests*
  • Patient Admission*
  • Point-of-Care Testing*
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors