Ischemic aetiology, self-reported frailty, and gender with respect to cognitive impairment in chronic heart failure patients

Abstract

BackgroundDecisive information on the parameters involved in cognitive impairment in patients with chronic heart failure is as yet lacking. Our aim was to determine the functional and psychosocial variables related with cognitive impairment using the mini-mental-state examination (MMSE) with age-and education-corrected scores.MethodsA cohort study of chronic heart failure patients included in an integrated multidisciplinary hospital/primary care program. The MMSE (corrected for age and education in the Spanish population) was administered at enrolment in the program. Analyses were performed in 525 patients. Demographic and clinical variables were collected. Comprehensive assessment included depression (Yesavage), family function (family APGAR), social network (Duke), dependence (Barthel Index), frailty (Barber), and comorbidities. Univariate and multivariate logistic regression were performed to determine the predictors of cognitive impairment.ResultsCognitive impairment affected 145 patients (27.6 %). Explanatory factors were gender (OR: 2.77 (1.75–4.39) p < 0.001), ischemic etiology (OR: 1.99 (1.25–3.17) p = 0.004), frailty (OR: 1.58 (0.99 to 2.50, p =0.050), albumin > 3.5 (OR: 0.59 (0.35–0.99) p = 0.048), and beta-blocker treatment (OR: 0.36 (0.17 to 0.76, p = 0.007)). No association was found between cognitive impairment and social support or family function.ConclusionThe observed prevalence of cognitive impairment using MMSE corrected scores was 27.6 %. A global approach in the management of these patients is needed, especially focusing on women and patients with frailty, low albumin levels, and ischemic aetiology heart failure.

Gender Differences in the Impact of Cognitive Function on Health Literacy among Older Adults with Heart Failure

“…Elderly women in our sample had lower levels of cognitive function with higher prevalence of cognitive impairment than men. Our result confirmed that women with HF had lower cognitive function when compared to men [13,34]. However, it was not in concordance with previous studies which showed that women had an advantage over men in verbal memory tasks [35].…”

“…Lower educational attainment and personal income may influence increased risk of cognitive impairment because lower socio-economic status is associated with poor nutritional intake, less access to healthcare services, less social activity and less interpersonal communication, all of which can lead to social isolation [18,36]. On the other hand, other studies have noted that men may experience faster verbal memory decline with the earlier onset of CAD and a higher risk for incident mild cognitive impairment [13]. However, even though there was a higher prevalence of CAD among men in this study, cognitive impairment was significantly prevalent among women.…”

“…Some studies on gender differences in cognitive function reported that women score better than men on tests of verbal abilities, and in contrast, men perform better than women on tests of visuospatial skills in general [8,10]. According to a recent study [13], women showed patterns with slower cognitive decline and poorer executive function than men. A retrospective study on patients awaiting cardiac transplant have shown that female patients had significantly greater cognitive impairments in psychomotor speed and language than male patients [14].…”

Physical Frailty and Cognitive Functioning in Korea Rural Community-Dwelling Older Adults

“…The biological basis of frailty has not been clearly identified yet. It could reflect cumulative results of pathophysiological modifications caused by concurrent chronic conditions [ 8 ], subclinical adaptation of systemic homeostatic mechanisms [ 9 ], metabolic modifications, and behavioral factors [ 5 ]. Some pathways are shared by frailty and mild cognitive impairment/Alzheimer’s disease (AD).…”

The Benefit of Prophylactic Implantable Cardioverter Defibrillator Implantation in Asymptomatic Heart Failure Patients With a Reduced Ejection Fraction

“…In daily clinical practice, patients are referred for ICD implantation based on multiple clinical parameters, such as frailty and overall prognosis. Severity of HF is associated with age, co-morbidities, and lower social status, 21,22 and it is possible that patients with severe HF are more often refused for prophylactic ICD therapy. This may influence the comparison of the benefit of ICD therapy in asymptomatic and symptomatic HF patients.…”