Cognition, Physical Function, and Quality of Life in Older Patients With Acute Decompensated Heart Failure
Section snippets
Study Design and Participants
This study is a cross-sectional analysis of the baseline assessment of the first 202 consecutively enrolled participants in the ongoing, National Institutes of Aging–sponsored, multicenter physical intervention trial, REHAB-HF, 198 of whom underwent cognitive screening. The design of REHAB-HF, including eligibility criteria and ADHF diagnosis confirmation, have been previously described.13,14 Briefly, patients were ≥60 years old and hospitalized for ≥24 hours for ADHF (regardless of ejection
Participant Characteristics
A total of 198 consecutively enrolled patients with cognitive data were included in this analysis. Patients averaged 72.1 ± 7.6 years of age, were mildly obese (BMI 33.2 kg/m2), and represented nearly equal proportions of males and females (46% vs. 54%) and whites and non-whites (52% vs. 48%). The majority (81%) had ≥12 years of formal education and 33% lived alone (Table 1).
Comorbidity burden was high with the majority of patients having hypertension (92%) and diabetes mellitus (55%). Also,
Discussion
This study systematically assessed cognitive dysfunction and examined its relationships with multiple measures of other important patient outcomes, including physical function and QOL, across multiple academic and community sites in an older, diverse ADHF population. We found that (1) CI was highly prevalent, (2) CI involved predominantly visuospatial, executive function, and recall domains, and (3) CI was associated with severe physical dysfunction and poor QOL. Each of these impairments is
Conclusions
Although the overwhelming majority of older hospitalized patients with ADHF had MoCA scores suggestive of CI, it was nearly always unrecognized clinically. Moreover, CI was global, affecting most domains of cognitive function, and was associated with severe impairments in physical function and QOL. Concomitant cognitive and physical impairment implies coordinated, systemic dysfunction, which has high potential to jeopardize patient HF self-management, safety, and functional independence. These
Declaration of Competing Interest
Dr. Kitzman is a consultant for AstraZeneca, Abbvie, GlaxoSmithKline, Merck, Corvia Medical, Bayer, CinRx, Boehringer-Ingleheim, and St. Luke's Medical Center in Kansas City, Kansas; received grant support from Novartis, AstraZeneca, Bayer, and St. Luke's Medical Center in Kansas City, Kansas; and owns stock in Gilead Sciences. Dr. Mentz receives research support from the National Institutes of Health (U01HL125511-01A1 and R01AG045551-01A1), Akros, Amgen, AstraZeneca, Bayer, GlaxoSmithKline,
Financial Disclosures
Supported in part by the following research grant awards from the National Institutes of Health: R01AG045551 and R01AG18915. Also supported in part by the Kermit Glenn Phillips II Chair in Cardiovascular Medicine at Wake Forest School of Medicine (DWK); the Claude D. Pepper Older Americans Independence Center (OAIC) NIH Grants P30AG021332 (DWK) and P30AG028716 (AMP); the Wake Forest Clinical and Translational Science Award, NIH Grant UL1TR001420, and the OAIC National Coordinating Center
Sponsor's Role
None.
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2022, Cardiology ClinicsCitation Excerpt :Finally, it may be reasonable to consider deprescribing commonly used agents with limited benefit—for example, beta-blockers are commonly used in HFpEF (86% prevalence in a recent randomized controlled trial),33 but they have limited data supporting benefits specifically for HFpEF,34,35 and some emerging data indicating potential for harm.36 The reported prevalence of cognitive impairment among patients with HF ranges from 22% to 78%.37,38 These differences reflect variations in the populations studied and diagnostic tools used across studies.