Six-item screener for cognitive and prognostic assessment in heart failure: A comparison with the mini-cog

Cognitive dysfunction is prevalent in patients with heart failure (HF) and predicts poor prognosis. The Six-Item Screener is a brief tool that requires no materials and can be administered easily in a variety of care settings. We evaluated whether this tool detects cognitive dysfunction and predicts all-cause mortality in older HF patients, in comparison with the Mini-Cog.

We conducted a post-hoc analysis of consecutive patients aged ≥65 years from the multicenter FRAGILE-HF cohort. Cognitive dysfunction at discharge was defined as Six-Item Screener ≤4 and Mini-Cog ≤2. Agreement was quantified using Cohen's kappa. Associations with all-cause mortality were examined with multivariable Cox proportional hazards models. Prognostic capabilities were assessed by the area under the receiver operating characteristic curve (AUC) and compared using the DeLong test.

Of 1332 enrolled patients, 1316 were included in the analysis (median age 81 years; 56.8 % male). The prevalence of cognitive dysfunction was 42.9 % by the Six-Item Screener and 38.5 % by the Mini-Cog, showing moderate agreement (kappa = 0.55). Cognitive dysfunction defined by the Six-Item Screener [hazard ratio (HR), 1.30; 95 % confidence interval (CI), 1.02-1.65; p = 0.034] and by the Mini-Cog (HR, 1.44; 95 % CI, 1.13-1.83; p = 0.003) was associated with higher all-cause mortality. AUCs were similar for the Six-Item Screener (0.553; 95 % CI, 0.515-0.592) and the Mini-Cog (0.556; 95 % CI, 0.519-0.594).

In older patients with HF, the Six-Item Screener identifies cognitive dysfunction and predicts mortality with prognostic performance comparable to the Mini-Cog.