Cognitive impairment predicts mortality in outpatient veterans with heart failure

Lan, Howard Haw-Chang; Hawkins, Lee Ann; Kashner, Michael; Perez, Elena V.; Firek, Christopher J.; Silvet, Helme

doi:10.1016/j.hrtlng.2018.06.008

Cited by 20 publications

(13 citation statements)

References 52 publications

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“…Our study has important practical implications because patients with HF who are more cognitively compromised have worse outcomes, such as lower self-care, 22 higher mortality, 27 and more frequent hospitalizations. 28 Our findings showed that exercise capacity, a modifiable factor, was independently associated with CI.…”

Section: Discussionmentioning

confidence: 99%

Cognitive impairment in patients with heart failure: an international study

et al. 2019

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Aims Cognitive impairment (CI) in heart failure (HF) patients has mostly been studied in single countries in specific health care settings. Sociodemographic and clinical predictors of the global CI and CI dimensions are still unclear. We described CI in a diverse HF population recruited in several countries and in different health care settings and investigated sociodemographic and clinical factors associated with the global and specific CI dimensions in HF patients. Methods and results A secondary analysis from the baseline data of the Wii‐HF trial. Patients (n = 605) were enrolled in Sweden, Italy, Israel, The Netherlands, Germany, and the United States. We used the Montreal Cognitive Assessment to evaluate CI and the 6 minute walk test (6MWT) to measure exercise capacity. Patients were on average 67 years old (SD, 12), and 86% were in New York Heart Association Class II and III. The mean Montreal Cognitive Assessment score was 24 (SD, 4), and 67% of patients had at least a mild CI. The item evaluating short‐term memory had a considerable proportion of low scoring patients (28.1%). Worse CI was associated with patients' older age, lower education, and lower 6MWT scores (R2 = 0.27). CI dimension scores were differently associated with specific clinical and demographic variables, but the 6MWT scores were associated with five out of seven CI dimension scores. Conclusions CI is an important problem in HF patients, with specific challenges in regard to memory. Exercise capacity is a modifiable factor that could be improved in HF patients with the potential to improve cognition and other outcomes in this population.

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Section: Discussionmentioning

confidence: 99%

Cognitive impairment in patients with heart failure: an international study

et al. 2019

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“…Huijts et al [13] reported the lowest cognitive impairment prevalence at 9.2%, whereas the study by Lan et al [14] showed the highest cognitive impairment prevalence at 57.6%. This major difference was likely due to a variation in participants’ demographic and screening instruments.…”

Section: Discussionmentioning

confidence: 93%

“…Several studies have been conducted to study the impact of cognitive impairment on mortality in patients with HF [12], [13], [14], [15], [16], [17], [18]. However, there has been no systematic review or meta-analysis to confirm this relation.…”

Section: Introductionmentioning

confidence: 99%

Cognitive impairment associated with increased mortality rate in patients with heart failure: A systematic review and meta-analysis

Kewcharoen

Prasitlumkum

Kanitsoraphan

et al. 2019

Journal of the Saudi Heart Association

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BackgroundRecent systematic review and meta-analysis showed that the prevalence of cognitive impairment was significantly increased in patients with heart failure (HF) when compared to the general population. However, the effect of cognitive impairment on cardiovascular outcome in this population is still unclear. We performed a systematic review and meta-analysis to assess whether cognitive impairment associated with worse outcome in patients with HF.MethodsWe comprehensively searched the databases of MEDLINE and EMBASE from inception to October 2018. Included studies were published cohort (prospective or retrospective) or randomized control trials that evaluate the effect of cognitive impairment mortality in HF patients. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate pooled hazard ratios (HR) and 95% confidence intervals (CI).ResultsEight studies were included in the analysis involving 3318 participants (951 participants had cognitive impairment). In a random-effects model, our analysis demonstrated that cognitive impairment significantly increased the risk of mortality in HF patients (pooled HR = 1.64, 95% CI = 1.42–1.88, I2 = 0.0%, p < 0.001).ConclusionOur systematic review and meta-analysis showed that the presence of cognitive impairment is strongly associated with an increased mortality risk in the HF population. Further research is needed to explore the pathophysiology of this association.

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“…Among community‐based older adults with HF, cognitive impairment has complex cross‐sectional associations with physical frailty, sleep disorders, and mood disorders including depression, anxiety, and hopelessness . Cognitive impairment has been linked to a variety of poor outcomes including worse health‐related quality of life, increased spousal/caregiver distress, increased disability, worse cardiovascular outcomes at 180 days, and increased mortality risk . A common link, which has immense practical implications for clinicians caring for older adults with HF, is that cognitive impairment in this population is associated with worse self‐management, self‐care, and self‐confidence .…”

Section: Heart Failurementioning

confidence: 99%

“…[14][15][16][17] Cognitive impairment has been linked to a variety of poor outcomes including worse health-related quality of life, increased spousal/caregiver distress, increased disability, worse cardiovascular outcomes at 180 days, and increased mortality risk. 18,19 A common link, which has immense practical implications for clinicians caring for older adults with HF, is that cognitive impairment in this population is associated with worse self-management, self-care, and self-confidence. 20 A high index of suspicion is warranted as patients with cognitive impairment are less likely to seek assistance.…”

Section: Heart Failurementioning

confidence: 99%

Integrating assessment of cognitive status in elderly cardiovascular care

Gorodeski

Hashmi

2019

Clinical Cardiology

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Cardiovascular clinicians tend to pay little attention to issues related to cognition, and yet those caring for older adults will encounter a variety of conditions that may lead to cognitive impairment. Most commonly, these include cardiovascular disease‐specific conditions such as cerebrovascular disease or heart failure, but may also include neurodegenerative conditions, mood disorders, medication side effects and polypharmacy, and nutritional deficiencies and metabolic derangements among others. This review presents evidence supporting the importance of assessing cognitive status in older adults with cardiovascular disease, and suggests a practical approach to assessment and management of cognitive impairment in this population when it is found. Special attention is paid to the importance of collaboration between cardiovascular and geriatric specialists, and the value it may bring to patients.

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Cognitive impairment predicts mortality in outpatient veterans with heart failure

Cited by 20 publications

References 52 publications

Cognitive impairment in patients with heart failure: an international study

Cognitive impairment in patients with heart failure: an international study

Cognitive impairment associated with increased mortality rate in patients with heart failure: A systematic review and meta-analysis

Integrating assessment of cognitive status in elderly cardiovascular care

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