Clinical study
The effects of cognitive impairment on mortality among hospitalized patients with heart failure

https://doi.org/10.1016/S0002-9343(03)00264-XGet rights and content

Abstract

Purpose

Cognitive impairment is a common, potentially reversible condition among older patients with heart failure. Because cerebral metabolic abnormalities have been associated with reduced survival in younger patients with advanced heart failure, we assessed the effect of cognitive impairment on the survival of older patients with heart failure.

Methods

The association between cognitive dysfunction and in-hospital mortality was assessed in 1113 patients (mean [± SD] age, 78 ± 9 years) who had been admitted for heart failure to 81 hospitals throughout Italy. One-year mortality was assessed in 968 patients with heart failure (age, 76 ± 10 years) participating in the same study. Cognitive impairment was defined as a Hodkinson Abbreviated Mental Test score <7.

Results

In-hospital death occurred in 65 (18%) of the 357 participants with cognitive impairment and in 26 (3%) of the 756 patients with normal cognition (P <0.0001). Out-of-hospital mortality was 27% (51/191) among patients with cognitive impairment and 15% (115/777) among other participants (P <0.0001). In multivariate Cox regression models, decreasing levels of cognitive functioning were associated with increasing in-hospital mortality; cognitive impairment was associated with an almost fivefold increase in mortality (relative risk = 4.9; 95% confidence interval: 2.9 to 8.3) after adjusting for several potential confounders.

Conclusion

Cognitive impairment is an independent prognostic marker in older patients with heart failure. Assessment of cognitive functioning, even by simple screening tests, should be part of the routine assessment of elderly patients with heart failure.

Section snippets

Study sample

We used the database of the Gruppo Italiano di Farmacoepidemiologia nell’Anziano (GIFA), a collaborative pharmacoepidemiology hospital study (16). Briefly, all patients admitted to 81 clinical centers (either geriatric or internal medicine hospital wards) throughout Italy from May 1 to June 30 and from September 1 to October 31 in 1988, 1991, 1993, 1995, and 1997 were enrolled on admission and followed until discharge, without exclusion criteria. The 16,913 participants included patients of all

Results

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% (647/1860) of participants with any diagnosis of heart failure, and in 28% (4229/15,053) of the remaining subjects (P <0.0001). Among those with heart failure, the mean (± SD) length of hospital stay was similar for patients with cognitive impairment (15 ± 10 days) as compared with those with normal cognitive functioning (15 ± 9 days).

Among

Discussion

We found that cognitive impairment was associated with decreased survival among older patients hospitalized for heart failure. This suggests that diminished cognition, as diagnosed by simple neuropsychological testing, might be a new prognostic marker for the routine assessment of these patients. The association between cognitive impairment and in-hospital mortality was not explained by delayed discharge from hospital, or by reduced availability of caregivers for home care. In addition,

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    The Gruppo Italiano di Farmacoepidemiologia nell’Anziano (GIFA) study was supported by a grant (n. 94000402) from the National Research Council, Rome, Italy.

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