Alzheimer's disease and related dementias and heart failure: A community study

Abstract

Background Cognitive function is essential to effective self‐management of heart failure (HF). Alzheimer's disease and Alzheimer's disease‐related dementias (AD/ADRD) can coexist with HF, but its exact prevalence and impact on health care utilization and death are not well defined. Methods Residents from 7 southeast Minnesota counties with a first‐ever diagnosis code for HF between January 1, 2013 and December 31, 2018 were identified. Clinically diagnosed AD/ADRD was ascertained using the Centers for Medicare and Medicaid (CMS) Chronic Conditions Data Warehouse algorithm. Patients were followed through March 31, 2020. Cox and Andersen‐Gill models were used to examine associations between AD/ADRD (before and after HF) and death and hospitalizations, respectively. Results Among 6336 patients with HF (mean age [SD] 75 years [14], 48% female), 644 (10%) carried a diagnosis of AD/ADRD at index HF diagnosis. The 3‐year cumulative incidence of AD/ADRD after HF diagnosis was 17%. During follow‐up (mean [SD] 3.2 [1.9] years), 2618 deaths and 15,475 hospitalizations occurred. After adjustment, patients with AD/ADRD before HF had nearly a 2.7 times increased risk of death, but no increased risk of hospitalization compared to those without AD/ADRD. When AD/ADRD was diagnosed after the index HF date, patients experienced a 3.7 times increased risk of death and a 73% increased risk of hospitalization compared to those who remain free of AD/ADRD. Conclusions In a large, community cohort of patients with incident HF, the burden of AD/ADRD is quite high as more than one‐fourth of patients with HF received a diagnosis of AD/ADRD either before or after HF diagnosis. AD/ADRD markedly increases the risk of adverse outcomes in HF underscoring the need for future studies focused on holistic approaches to improve outcomes.

Frequency and implications of coexistent manifestations of serious illness in older adults with dementia

“…Compared to the overall population of older adults with an advanced medical condition, the subset with an advanced medical condition and dementia are more costly for Medicare, and are more likely to have hospital and emergency department visits. This is in line with other studies of dementia and advanced medical conditions which demonstrate high costs of care, higher risk of mortality and/or increased healthcare utilization when dementia and an advanced medical condition co‐occur 15,23,24 . Interestingly, the same pattern was not observed when the overall population of older adults with ADL impairment were compared with the subset who had ADL impairment and dementia.…”

“…This is in line with other studies of dementia and advanced medical conditions which demonstrate high costs of care, higher risk of mortality and/or increased healthcare utilization when dementia and an advanced medical condition co-occur. 15,23,24 Interestingly, the same pattern was not observed when the overall population of older adults with ADL impairment were compared with the subset who had ADL impairment and dementia. While disability in the setting of dementia is known to increase the risk of mortality and costs of care, our results add novel evidence that costs are not substantially greater for older adults with ADL impairment and dementia than for the general population with ADL impairment.…”

Serum phosphorylated tau protein 181 and neurofilament light chain in cognitively impaired heart failure patients

“…There is strong epidemiological evidence that chronic HF predisposes to the development of AD [ 4 , 5 ]. Accordingly, increased serum pTau in our HF cohort, which excluded patients with overt dementia at study entry, may indicate incipient AD development since serum/plasma pTau is considered a specific biomarker for AD [ 25 ].…”

“…Whereas a strict dividing line was once conceptually drawn between AD and vascular dementia, it is now widely accepted that cardio- and cerebrovascular risk factors significantly increase the likelihood of developing AD [ 2 , 3 ]. In addition to stroke, chronic heart failure (HF) in particular predisposes to the development of AD, as shown in population-based studies [ 4 , 5 ]. HF is a common and serious consequence of many cardiac diseases and carries a grave prognosis [ 6 ].…”

Heart failure and cognitive impairment: Complexity that requires a new approach

“…In this issue of the Journal of the American Geriatrics Society , Manemann and colleagues 1 present data on the prevalence of heart failure (HF) with concurrent Alzheimer's Disease and Related Dementias (ADRD), and its impact on healthcare utilization. Using data from 6336 patients in 7 southeast counties in Minnesota with a mean age of 75 years, the authors found that 10% had a diagnosis of ADRD at the time of their HF diagnosis and that the 3‐year cumulative incidence of developing ADRD after HF diagnosis was 17%.…”