P171 - SCREENING FOR DEPRESSION, OBSTRUCTIVE SLEEP APNEA, AND COGNITIVE IMPAIRMENT TO PREDICT ADVERSE OUTCOMES IN HEART FAILURE PATIENTS: THE CARDIACDOC PROSPECTIVE COHORT STUDY

Background: Heart failure (HF) affects 600,000 Canadians and is associated with poor long-term morbidity and 50% mortality at 5 years. Multi-morbidity is common in HF patients: 40% have >5 non-cardiovascular co-morbidities, with Depression, Obstructive sleep apnea and Cognitive impairment (DOC) among the most prevalent. Although common, DOC conditions are often under-diagnosed, screening guidelines are limited, and whether these comorbidities are predictive of adverse outcomes remains unclear.

METHODS AND RESULTS:

Methods: Consecutive patients a minimum of 3 months after a confirmed HF diagnosis were screened for DOC during a routine visit to a tertiary advanced HF clinic using a brief clinical tool (www.docscreen.ca), previously validated in stroke populations. The primary feasibility outcome was screening time, to assess if the screening tool could be administered to patients in < 6 minutes within clinic workflow. The secondary outcome was the proportion of patients screening low, intermediate, and high risk for each DOC comorbidity. DOC screen results will be linked to administrative health data via ICES to build prediction models for adverse complications including mortality, readmission for HF, and admissions for diabetes complications, falls, chronic obstructive pulmonary disease, cellulitis, dehydration, and pneumonia.

Results: To date, N=163 patients (N=35 female, N=128 male; mean age=59, range 19-87) with advanced HF (median NYHA classification = II) have been screened in the University of Ottawa Heart Institute HF clinic. Results for the primary feasibility outcome showed that the DOC screen was successfully completed in < 6 minutes for 99% of patients, with a mean completion time of 3.82 min (SD= 0.82). Secondary outcomes showed the proportion of patients screening high-risk for Depression (4-6 points), Obstructive Sleep Apnea (4 points), and Cognitive Impairment (0-5 points) was 12%, 5%, and 15%, respectively. HF patients showed moderate depression risk, with the largest proportion of patients screening low-risk (48% scoring 0 points). However, by contrast, only 6% of patients screened low-risk for Cognitive Impairment (10 points), leaving 94% screening as either intermediate or high-risk (scoring 6–9 and 0–5 points, respectively).

Conclusion: The results of this feasibility study demonstrate the practicality of integrating the DOC Screen into routine HF clinic visits, as 99% of screens were completed within the 6-minute threshold. Nearly 95% of patients were found to have an intermediate to high risk of cognitive impairment, highlighting the urgent need to integrate cognitive screening into standard of care for HF patients. Future research will assess the predictive utility of DOC comorbidities for long-term clinical implications.