Cognitive Impairment in Heart Failure Linked to Worse Prognosis

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heart beat
The risk increase is likely due to mismanagement of medications.

Cognitive impairment in people with heart failure can increase risk of death and heart failure readmission, according to data presented at Heart Failure 2015.

The risk, which increased more than seven-fold, is associated with patients becoming progressively worse at remembering to take medications, which affect prognosis.

“Systematic reviews have shown that cognitive impairment is common in patients with chronic heart failure. However, the impact of cognitive impairment on the prognosis of heart failure patients is not known,” said study author Hiroshi Saito, of Kameda Medical Center in Kamogawa, Japan. “Our study investigated whether cognitive impairment independently predicted the outcome of elderly patients with heart failure.”

The study, presented by Hiroshi Saito of Kameda Medical Center in Kamogawa, Japan, included 136 patients aged 65 years and older with heart failure (average 82 yrs; 47% men). All participants were given the Mini Mental State Examination (MMSE) to assess cognitive health prior to discharge. Patients were then split into two groups: those with a cognitive disorder (MMSE score <27) and those without a cognitive disorder (MMSE score >27).

Based on MMSE scores, 74% (101) of patients had a cognitive disorder. After 161 days, 24% (33) were readmitted due to heart failure or died. Prognosis of the cognitively impaired group was significantly worse than the non-impaired group, with a 7.5 times greater risk of worse prognosis in patients with heart failure. The risk remained after adjusting for age, gender, BMI, albumin, hemoglobin, brain natriuretic peptide (BNP), C-reactive protein (CRP), ejection fraction, estimated glomerular filtration rate (eGFR), and blood urea nitrogen (BUN).

“We expect that heart failure patients with cognitive impairment tend to get progressively worse at adhering to medications. It is possible that this could explain why they have a worse prognosis. Cardiologists and other medical staff should assess the cognitive status of elderly heart failure patients,” Saito said. “When cognitive status is impaired we should provide education on disease management to families to prevent heart failure readmission of their loved ones. The three major components of this are medication, nutrition, and exercise. Of these three components, medication is an especially important element. It is necessary for families to enhance medication adherence for patients who are unable to manage their medication by themselves.”