The Effects of Cognitive Impairment on Hospitalizations in Heart Failure Patients

Background: Heart failure (HF) is a major health problem in the United States (US) linked to poor survival rates, high rehospitalization rates and high healthcare cost. HF is positively associated with aging and its impact on US health and healthcare systems is expected to grow as the baby boomer generation enters their retirement years. The same is true for another chronic health risk, cognitive impairment. There is a clear, negative impact on prognosis and healthcare outcomes associated with cognitive impairment in HF patients, but less is known about how these affect systems outcomes such as overall hospitalization. The aim of this study is to compare hospitalization patterns among HF patients with and without comorbid cognitive impairment to identify associated risks and outcomes. Methods: We performed a cross-sectional study of adults over the age of 45 with a diagnosis of heart failure. The data for this analysis was obtained from the 2014 Medical Expenditure Panel Survey (MEPS). Statistical analyses were performed using SPSS. Differences in the distribution of risk for patients with and without cognitive disorders were evaluated using weighted Chi-squared tests. A weighted logistic regression was used to find factors associated with hospitalization risk by examining associations among demographic and other characteristics with the outcome. Results: A total of 175 adults were studied. There was evidence of a statistically significant association between the presence of cognitive impairment and hospitalization (X² = 5661.545, p<0.0001). However, the association between the two was very weak (Cramer's V = 0.053, p<0.000; Pearson's R = -0.053, p<0.000). A logistic regression model was fit to assess associations between the outcome and insurance coverage, cognitive impairment, race, sex, age, annual family income and education. The odds of hospitalization were 1.15 times more when a subject is uninsured, as compared to those who were insured (p<0.0001), all other factors held constant. Similarly, those without cognitive impairment had 1.33 times the odds of hospitalization compared to that of those with cognitive impairment (p<0.0001). White subjects were found to have an 88% increase in odds of hospitalization compared to their non-White counterparts (p<0.0001). Men were expected to have a 13% increase in odds of hospitalization (p<0.0001). Younger age was a protective factor; there was a 40% reduction in odds of hospitalization for subjects under 65 years old (p<0.0001). Subjects with an annual family income under $35,000 were at 2.5-fold increased odds of hospitalization (p<0.0001). Education also showed to be a significant protective factor. Subjects with less than a high school education had 5.3 times the odds of hospitalization compared to subjects with at least a Bachelor's degree. Subjects with a high school diploma and/ or some college had a 2.4-fold increase in odds of hospitalization compared to those with at least a Bachelor's degree (p<0.0001). Conclusions: Consistent with the literature, populations with older age, less education and lower income were at a higher risk of hospitalization. However, this study ultimately found no evidence that supports the theory that cognitive impairment affects hospitalizations in heart failure patients. It is plausible that the high prevalence and relatedness of comorbidities between cognitive impairment, race, socioeconomic status, education, and age simply mask the effects of cognitive impairment on hospitalizations. These results warrant the continued study of the effects of cognitive impairment and number of hospitalizations, in addition to overall risk of hospitalization.