Mini-Cog as an independent determinant of medication self-management autonomy in hospitalized patients with heart failure
T Kurosaki, M Ueda, M Endo, K Hiroe, N Fukunaga, T OhtaAbstract
Background
Maintaining medication adherence is critically important in disease management for patients with heart failure (HF), with reported associations between patient age, physical function, and cognitive function. While several studies have evaluated the relationship between cognitive function and HF self-management (including medication management) using the Mini-Mental State Examination (MMSE), no previous study has examined this association using the Mini-Cog, a more convenient and practical screening tool.
Objective
This study aimed to investigate whether the Mini-Cog, a cognitive function test, is an independent predictor of medication self-management ability in hospitalized patients with heart failure.
Methods
We retrospectively analyzed 51 hospitalized HF patients at our institution who underwent Mini-Cog assessment. Medication self-management ability was assessed using the Medication Independence Scale (Grade 1: capable of self-management; Grade 2: requires dispensing of medication per prescribed dose; Grade 3: requires supervision; Grade 4: requires partial assistance; Grade 5: unable to take medication), classifying patients into a ‘medication-independent group’ (Grades 1 and 2) and a ‘medication support-required group’ (Grades 3 to 5). Multivariate logistic regression analysis was performed using medication self-management capability as the dependent variable and Mini-Cog score, age, and physical function (FIM motor subscale) as explanatory variables. Furthermore, the predictive accuracy of the Mini-Cog for medication self-management capability was evaluated using ROC curve analysis.
Results
Patients were classified as medication-independent group (33, 65%) and medication support-required group (18, 35%). Significant differences existed between groups in Mini-Cog scores (median 5 [5–5] vs 2 [1–3], p<0.001), age (median 82.5 [76.3–89.3] years vs 90 [86–91] years, p<0.003), and FIM motor subscale score at admission (median 37 [24.3–55.5] vs 26 [17.3–28], p=0.003). No significant differences were observed in the number of daily medication doses or the number of medications administered. In the multivariate analysis, only the Mini-Cog score was a significant and independent predictor of medication independence (odds ratio 4.93, 95% CI 1.78–13.7, p=0.002). Age (p=0.164) and physical function (FIM motor subscale; p=0.473) were not significant predictors. ROC analysis identified a Mini-Cog cut-off value of 4 as optimal for predicting medication independence, with an area under the curve (AUC) of 0.888 (95% CI: 0.783–0.993). The sensitivity and specificity at this cut-off were 0.939 and 0.778, respectively.
Conclusion
Mini-Cog was an independent predictor of medication adherence autonomy in patients with heart failure. The Mini-Cog is a highly convenient and useful cognitive screening tool and is considered valuable as a cognitive function assessment tool for self-care in patients with HF, including medication management.