Heart Failure
Prevalence of Memory Disorders in Ambulatory Patients Aged ≥70 Years With Chronic Heart Failure (from the EFICARE Study)

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The aim of this multicenter observational study conducted in France was to determine the prevalence of memory impairment in ambulatory patients aged ≥70 years with chronic heart failure (HF). Two hundred ninety-one cardiologists recruited 912 ambulatory patients with HF (mean age 79.2 ± 5.8 years) from January to November 2009. Memory was evaluated by the delayed-recall Memory Impairment Screen (MIS-D). Memory impairment was defined as MIS-D score ≤6 and severe memory impairment as MIS-D score ≤4. HF was diagnosed 4.4 ± 4.8 years earlier and mean left ventricular ejection fraction was 43.6 ± 12.0%. Memory impairment was found in 416 subjects (45.6%, 95% confidence interval 42.4 to 48.8) and severe memory impairment in 213 subjects (23.4%, 95% confidence interval 20.6 to 26.1), whereas cardiologists only suspected memory impairment in 109 patients (12%; before evaluation by MIS). Determinants of memory disorders included older age, lower education level, depression, history of stroke, renal failure, and less regular physical activity. The severity of memory impairment increased with increasing severity of HF (New York Heart Association classification; p <0.00001). In conclusion, memory impairment in older patients with HF is common. The use of a simple-to-use tool such as the MIS-D may identify patients at risk and enable implementation of management strategies to improve therapeutic compliance.

Section snippets

Methods

EFICARE study is an observational study of ambulatory patients aged ≥70 years with symptomatic HF living in France. Private practice cardiologists were contacted by phone and invited to participate in the study. They were equally distributed by region. To ensure recruitment of a representative population from France as a whole, each cardiologist was asked to recruit the first 4 consecutive patients seen for a routine consultation who met the following criteria: men or women aged ≥70 years, HF

Results

General characteristics of the population (n = 912) at baseline are listed in Table 1. Mean age was 79.1 ± 5.8 years and 590 subjects (65%) were men. Compared with patients with MIS-D[7-8], subjects with MIS-D[0-6] were older, more often women, and had a lower education level. They were also more likely to have renal failure, a history of stroke, depression, and at least 1 fall in the last 12 months and were less likely to be physically active. As expected, level of functional impairment (IADL

Discussion

In this large sample of community-dwelling patients aged ≥70 years with HF, we showed that 46% of patients had memory impairment as identified by MIS-D. In contrast, only 12% of the patients were considered to have memory impairment based on the subjective evaluation by their cardiologists Severity of memory impairment increased with increasing severity of HF. Age, lower education level, low physical activity, depression, history of stroke, and renal failure were independently associated with

Acknowledgment

Data quality control was performed by Axonal S.A., Nanterre, France.

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    This study was supported by an unrestricted grant from A. Menarini Industrie Farmaceutiche Riunite Srl, Florence, Italy. Medical writing support was provided by Jenny Grice of inScience Communications, Springer Healthcare. This assistance was funded by A. Menarini Industrie Farmaceutiche Riunite Srl.

    See page 1209 for disclosure information.

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