Factors Contributing to Global Cognitive Impairment in Heart Failure: Results From a Population-Based Cohort

doi:10.1016/j.cardfail.2008.01.003

Journal of Cardiac Failure

Volume 14, Issue 4, May 2008, Pages 290-295

https://doi.org/10.1016/j.cardfail.2008.01.003 Get rights and content

Abstract

Background

Heart failure (HF) and cognitive impairment are both common in older adults. However, the association between the two has not been well studied.

Methods and Results

We explored the relationship between very probable HF, determined by self-reported symptoms, and cognitive impairment, defined as four or fewer correct on the Six-item Screener, in 14,089 participants of the Reasons for Geographic and Racial Differences in Stroke cohort. We determined the effect of adding demographic, socioeconomic status (SES), health behavior, and comorbidity covariates. In the univariate model, participants with very probable HF were 1.51 (95% confidence interval: 1.15–1.96) times more likely to have cognitive impairment than those without HF. As covariates were added to the model, the relationship between HF and cognitive impairment was attenuated and lost statistical significance after adjustment for depression. Demographic variables, Stroke Belt location (1.28 [1.11–1.48]), SES factors, prior stroke (1.43 [1.18–1.73]), and depression (1.66 [1.38–2.01]) remained significant in the multivariable model. Higher hemoglobin was associated (0.95 [0.9–1.00]) with modestly reduced odds of cognitive impairment.

Conclusions

The relationship between cognitive impairment and HF can be accounted for by multiple demographic and SES factors, and by comorbidities, some of which are modifiable. Persons with HF and cognitive impairment should be screened for anemia and depression.

Section snippets

Design

The REasons for Geographic And Racial Differences in Stroke (REGARDS) study is a population-based study of adults aged 45 years and older in the United States⁷ that seeks to determine causes of racial and geographic differences in stroke mortality. Data collection began in January of 2003 and is ongoing. On completion of recruitment, the cohort will consist of 30,000 participants, 50% from stroke-belt regions and 50% from other regions of the United States, 50% are white and 50% are black, 50%

Results

Table 1 presents the descriptive statistics overall and by HF category for all included participants. The results from the logistic regression modeling are presented in Table 2. The main relationship of interest is that between HF and cognitive status.

In the univariate modeling including all participants, there is a relationship between HF and cognitive status, in that those with very probable HF are 1.51 (95% CI: 1.16–1.96) times more likely to be cognitively impaired than those without HF.

Discussion

Cognitive impairment in HF is potentially an important public health issue because HF affects some 4.5 million Americans.¹⁵ There is mounting evidence that HF is associated with global cognitive impairment. We found that participants with very probable HF were more likely to be cognitively impaired than those without HF, although after adjustment for all potential confounders, the relationship between HF and cognitive impairment was no longer significant. We found prior stroke to be associated

Acknowledgments

The authors acknowledge the participating investigators and institutions: University of Alabama at Birmingham, Birmingham, Alabama (Study Principal Investigator, Data Coordinating Center, Survey Research Unit): George Howard, Leslie McClure, Virginia Howard, Libby Wagner, Virginia Wadley, Rodney Go, Ella Temple, Margaret Stewart; University of Vermont (Central Laboratory): Mary Cushman; Wake Forest University Medical Center (ECG Reading Center): Ron Prineas; Alabama Neurological Institute

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The presence of CI in the HF population is well documented in literature,38,39 with most studies including patients with heart failure with reduced ejection fraction. Higher prevalence is observed in patients with more severe symptoms and need for hospitalization.40–43 Our population, showing a significant rate (26%) of mild CI, fits this profile, as 86% had HFrEF, all were discharged from hospital after an episode of HF decompensation, and 60% had previous hospitalizations for HF.
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Cognitive function, anxiety and depressive status remain stable in HF patients despite optimized HF therapy. Cognitive status shall be routinely screened to adopt attitudes that improve management as it has an impact on HF-related QoL and prognosis.
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Avaliar o estado cognitivo dos doentes com IC ao longo do tempo, a sua relação com ansiedade/depressão e o seu impacto prognóstico.
Estudo prospetivo, longitudinal, unicêntrico de doentes seguidos num programa estruturado após internamento por IC descompensada. A função cognitiva, estado ansioso/depressivo, qualidade de vida (QV) relacionada com a IC foram avaliadas antes da alta e durante o seguimento (entre 6.°-12.° mês) utilizando o Montreal Cognitive Assessment (MoCA), a Hospital Anxiety and Depression Scale (HADS) e o Kansas City Cardiomyopathy Questionnaire (KCCQ), respetivamente. Avaliaram-se outcomes relacionados com IC: reinternamento por qualquer causa, reinternamentos por IC e objetivo composto de morte/reinternamento.
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: This research project is supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Services. Additional funding was provided by an investigator-initiated grant-in-aid from Amgen Corporation. Amgen did not have any role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; or the preparation or approval of the manuscript. The manuscript was sent to Amgen for review before submission for publication.

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Clinical TrialsMethods and DesignFactors Contributing to Global Cognitive Impairment in Heart Failure: Results From a Population-Based Cohort