Publication/Presentation Date
12-1-2019
Abstract
OBJECTIVES: This study sought to characterize cognitive decline (CD) over time and its predictors in patients with systolic heart failure (HF).
BACKGROUND: Despite the high prevalence of CD and its impact on mortality, predictors of CD in HF have not been established.
METHODS: This study investigated CD in the WARCEF (Warfarin versus Aspirin in Reduced Ejection Fraction) trial, which performed yearly Mini-Mental State Examinations (MMSE) (higher scores indicate better cognitive function; e.g., normal score: 24 or higher). A longitudinal time-varying analysis was performed among pertinent covariates, including baseline MMSE and MMSE scores during follow-up, analyzed both as a continuous variable and a 2-point decrease. To account for a loss to follow-up, data at the baseline and at the 12-month visit were analyzed separately (sensitivity analysis).
RESULTS: A total of 1,846 patients were included. In linear regression, MMSE decrease was independently associated with higher baseline MMSE score (p < 0.0001), older age (p < 0.0001), nonwhite race/ethnicity (p < 0.0001), and lower education (p < 0.0001). In logistic regression, CD was independently associated with higher baseline MMSE scores (odds ratio [OR]: 1.13; 95% confidence interval [CI]: 1.07 to 1.20]; p < 0.001), older age (OR: 1.37; 95% CI: 1.24 to 1.50; p < 0.001), nonwhite race/ethnicity (OR: 2.32; 95% CI: 1.72 to 3.13 for black; OR: 1.94; 95% CI: 1.40 to 2.69 for Hispanic vs. white; p < 0.001), lower education (p < 0.001), and New York Heart Association functional class II or higher (p = 0.03). Warfarin and other medications were not associated with CD. Similar trends were seen in the sensitivity analysis (n = 1,439).
CONCLUSIONS: CD in HF is predicted by baseline cognitive status, demographic variables, and NYHA functional class. The possibility of intervening on some of its predictors suggests the need for the frequent assessment of cognitive function in patients with HF. (Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction [WARCEF]; NCT00041938).
Volume
7
Issue
12
First Page
1042
Last Page
1053
ISSN
2213-1787
Published In/Presented At
Lee, T. C., Qian, M., Liu, Y., Graham, S., Mann, D. L., Nakanishi, K., Teerlink, J. R., Lip, G., Freudenberger, R. S., Sacco, R. L., Mohr, J. P., Labovitz, A. J., Ponikowski, P., Lok, D. J., Matsumoto, K., Estol, C., Anker, S. D., Pullicino, P. M., Buchsbaum, R., Levin, B., … WARCEF Investigators (2019). Cognitive Decline Over Time in Patients With Systolic Heart Failure: Insights From WARCEF. JACC. Heart failure, 7(12), 1042–1053. https://doi.org/10.1016/j.jchf.2019.09.003
Disciplines
Medicine and Health Sciences
PubMedID
31779926
Department(s)
Department of Medicine, Cardiology Division
Document Type
Article