Clinical research study
Correlates of cognitive impairment among patients with heart failure: Results of a multicenter survey

https://doi.org/10.1016/j.amjmed.2005.01.030Get rights and content

Abstract

Purpose

Cognitive impairment is an exceedingly prevalent condition among patients with heart failure, independently associated with disability and mortality. However, the determinants of cognitive dysfunction associated with heart failure are still unclear. We assessed the correlates of cognitive impairment among patients with heart failure enrolled in a multicenter pharmacoepidemiology survey.

Methods

The association with cognition of demographic characteristics, objective tests and measures, medications, and comorbid conditions was assessed in 1511 patients with heart failure who had been admitted to 81 hospitals throughout Italy. Cognitive impairment was defined by a Hodkinson Abbreviated Mental Test score < 7.

Results

According to multivariate logistic regression modeling, age (per each decade: OR = 2.01; 95% confidence interval [CI] 1.72–2.35), the comorbidity score (OR 1.11; 95% CI 1.03–1.20), education (OR 0.88; 95% CI 0.84–0.2), low serum albumin (OR 1.78; 95% CI 1.35–2.34), sodium (OR 1.56; 95% CI 1.06–2.29), and potassium levels (OR 1.58; 95% CI 1.09–2.29), hyperglycemia (OR 1.33; 95% CI 1.02–1.73), anemia (OR 1.38; 95% CI 1.09–1.75), and systolic blood pressure levels ≥ 130 mm Hg (OR 0.60; 95% CI 0.37–0.97) were independently associated with cognitive impairment, after adjusting for potential confounders. Among participants with abnormal laboratory findings on admission, restoration of normal glucose, potassium, and hemoglobin levels during hospital stay was associated with improved cognitive performance at discharge.

Conclusions

Cognitive impairment among patients with heart failure is associated with several comorbid conditions, some of which are potentially treatable. This highlights the key role of comprehensive approach to the assessment and treatment of patients with heart failure.

Section snippets

Study methods

We analyzed the database of the Gruppo Italiano di Farmacoepidemiologia nell’Anziano (GIFA), a large collaborative hospital study. This study has been approved by the Bioethical Committee at the Catholic University of the Sacred Heart in Rome. The methods of the GIFA have been described in detail elsewhere.17 Briefly, all 32 243 patients admitted to 81 clinical centers (either geriatric or internal medicine hospital wards) throughout Italy in several surveys were enrolled on admission and

Prevalent cognitive impairment according to diagnosis of heart failure

Among the 16 913 participants in the GIFA database who were suitable for analysis during the years of interest, cognitive dysfunction was detected in 35% (526/1511) of participants with diagnosis of heart failure and in 29% (3448/11 790) of the remaining subjects (P <0.0001).

Correlates of cognitive impairment among participants with heart failure

The main characteristics, according to presence of cognitive impairment, of the 1511 participants with a verified diagnosis of heart failure are depicted in Table 1.

In the initial age- and sex-adjusted logistic regression

Discussion

Despite advances in the care of patients with heart failure, uncertainty remains about effective management of elderly subjects with comorbidities.14 In fact, heart failure in older populations is still associated with impressive hospitalization and mortality rates, as well as prevalent functional disability.12, 13 Noncardiac comorbidity has been proven a major determinant of such persistently poor outcomes of treatment, and it has been hypothesized that comprehensive approaches might reduce

References (42)

  • G.C. Roman

    Brain hypoperfusiona critical factor in vascular dementia

    Neurol Res

    (2004)
  • G. Zuccalà et al.

    Left ventricular dysfunctiona clue to cognitive impairment in older patients with heart failure

    J Neurol Neurosurg Psychiatry

    (1997)
  • G. Zuccalà et al.

    Hypotension and cognitive impairmentselective association in patients with heart failure

    Neurology

    (2001)
  • C.W. Lee et al.

    Prognostic significance of cerebral metabolic abnormalities in patients with congestive heart failure

    Circulation

    (2001)
  • E. Georgiadis et al.

    Cerebrovascular reactivity is impaired in patients with cardiac failure

    Eur Heart J

    (2000)
  • G.A. Rosemberg et al.

    Cardiogenic dementia

    Lancet

    (1981)
  • P.M. Pullicino et al.

    Cognitive impairment in congestive heart failure? Embolism vs hypoperfusion

    Neurology

    (2001)
  • G. Zuccalà et al.

    Cognitive dysfunction as a major determinant of disability in patients with heart failureresults from a multicentre survey

    J Neurol Neurosurg Psychiatry

    (2001)
  • M.A. Konstam

    Progress in heart failure management? Lessons from the real world

    Circulation

    (2000)
  • M.W. Rich

    Heart failure in the 21st centurya cardiogeriatric syndrome

    J Gerontol A Biol Sci Med Sci

    (2001)
  • H. Koide et al.

    Improvement of cerebral blood flow and cognitive function following pacemaker implantation in patients with bradycardia

    Gerontology

    (1994)
  • Cited by (160)

    View all citing articles on Scopus

    The GIFA study was partially supported by a grant from the National Research Council (n.94000402). The work of Dr. Cesari was supported by the Wake Forest University Claude D. Pepper Older Americans Independence Center (NIA grant P30-AG-021332-03).

    View full text