Utility of the mini-mental state examination for assessing cognitive function in determining appropriate medication management strategies in patients with heart failure: a retrospective observational study

Patients with heart failure frequently experience recurrent hospitalizations, with poor medication adherence serving as a primary determinant of adverse clinical outcomes. Given the elevated prevalence of cognitive impairment among elderly patients with heart failure, the implementation of individualized medication management strategies is imperative. This study aimed to elucidate the association between Mini-Mental State Examination (MMSE) scores and the feasibility of various medication management strategies in hospitalized patients with heart failure. This retrospective observational study analyzed 148 patients with heart failure aged ≥ 65 years. Subjects were categorized into three groups based on their medication management at discharge: self-management via medication envelopes (press-through-package sheets or unit-dose packaging), self-management using a medication calendar, or nurse-assisted administration. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were performed to identify predictors of self-management feasibility. The MMSE score was the sole parameter showing significant differences across all pairwise comparisons between management groups. Multivariate analysis identified the MMSE score as an independent predictor for both self-management via envelopes and the necessity of adherence aids. For self-management utilizing medication envelopes, ROC analysis yielded an area under the curve (AUC) of 0.848, with an optimal cutoff threshold of ≥ 27 (sensitivity: 78.6%; specificity: 80.2%). For the broader feasibility of self-administration (using either envelopes or calendar), the AUC was 0.820, with a threshold of ≥ 24 (sensitivity: 83.7%; specificity: 67.9%). Additionally, patients of heart failure-related readmission associated with poor adherence occurred exclusively when established management protocols were discontinued post-discharge. MMSE scores may represent a valuable tool for predicting the successful establishment of medication management strategies. Specifically, scores below 27 suggest a need for adherence aids like medication calendar, while scores below 24 indicate a substantial requirement for external caregiver or nursing assistance to ensure therapeutic adherence.