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Cleveland Clinic Study Finds Simple Test of Patient Cognition May Predict Heart Failure Readmissions

Heart Failure Patients Who Performed Poorly on Short ‘Mini-Cog’ Quiz Twice as Likely to Be Readmitted or Die 30 Days after Discharge

Saturday, March 29, 2014

Researchers at Cleveland Clinic have found that a simple, three-step quiz completed by heart failure patients at discharge may predict who will be readmitted or die within 30 days after leaving the hospital, according to findings presented at a press conference today and as an oral presentation Sunday at the American College of Cardiology Scientific Sessions in Washington, D.C.

The Mini-Cog test was originally designed as a quick and easy way for healthcare professionals to identify patients who may be suffering from Alzheimer’s disease or dementia. This is the first time the Mini-Cog has been tested for its correlation to heart failure readmissions.

The three-part test first asks the patient to memorize three unrelated words. In step two, the patient is asked to draw a clock with a particular time on its face. In step three, the patient is asked to recall the three words from the first part of the test. Patients are graded on a five-point scale, with two points awarded for the clock drawing and one point for each correct word. A score of 2 or less indicates a high likelihood of cognitive impairment.

The study, led by Eiran Gorodeski, MD, MPH, Staff Cardiologist and Director of the Center for Connected Care at Cleveland Clinic, examined the Mini-Cog results of 720 patients hospitalized for heart failure, who completed the test as part of their routine inpatient care at Cleveland Clinic. Consistent with prior research that found high levels of cognitive impairment among heart failure patient populations, Gorodeski and his colleagues found that nearly one out of four heart failure inpatients (23 percent) who completed the Mini-Cog had a high likelihood of impairment. The 30-day readmission and mortality rate for these patients was more than twice as high as for the patients with a low likelihood of cognitive impairment (47 percent compared to 22 percent).

“Readmissions statistics, and heart failure readmissions numbers, in particular, are the subject of countless research studies and have perplexed the medical community for years,” said Dr. Gorodeski. “Yet, our results show that a simple test, which can be administered in a matter of minutes by clinicians, may be a powerful predictor of 30-day readmissions and mortality.”

The researchers also found that this effect was tampered a bit depending on whether the patient was discharged to home or to a skilled nursing facility. Patients who performed poorly on the Mini-Cog and were discharged to a facility saw a significant delay in the time before their first readmission event or death.

“As readmissions numbers play a more and more important role in the economics of our healthcare system, more research must be done to identify ways to stem the tide of heart failure readmissions,” Gorodeski said. “Much of our effort in this area has been focused on patient education – teaching patients how to care for themselves after discharge. But our results indicate that this might be a losing battle if a quarter of heart failure patients are cognitively impaired. Perhaps more emphasis should be placed on identifying the correct discharge location for patients based on their mental and physical needs. We also do not know if structured in-home support specifically designed for patients with cognitive impairment would lead to better outcomes.”

Moving forward, Gorodeski and his colleagues suggest that providers caring for patients with heart failure begin incorporating the Mini-Cog into their patient care routine. Given that the test is already known to medical professionals, repurposing it for use with heart failure patients would be seamless.

“Cognitive impairment is frequently subtle but we have to look for it,” Gorodeski concluded. “Patients who have difficulty with attention, memory, reasoning, planning, and execution, are unlikely to succeed in the complex self-care that is essential for managing their cardiac condition.”

This research was funded by a grant from The Doctors Company Foundation. The Doctors Company is the nation’s largest insurer of medical professional liability for physicians, surgeons, and other health professionals. Its nonprofit foundation supports patient safety education for health care professionals, patient safety research, and medical professional liability research.

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Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S.News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. More than 3,000 full-time salaried physicians and researchers and 11,000 nurses represent 120 medical specialties and subspecialties. The Cleveland Clinic health system includes a main campus near downtown Cleveland, eight community hospitals, more than 75 Northern Ohio outpatient locations, including 16 full-service Family Health Centers, Cleveland Clinic Florida, the Lou Ruvo Center for Brain Health in Las Vegas, Cleveland Clinic Canada, and, currently under construction, Cleveland Clinic Abu Dhabi. In 2012, there were 5.1 million outpatient visits throughout the Cleveland Clinic health system and 157,000 hospital admissions. Patients came for treatment from every state and from more than 130 countries. Visit us at Follow us at

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