Prognostic importance of cognitive impairment in chronic heart failure patients: Does specialist management make a difference?

doi:10.1016/j.ejheart.2005.11.013

European Journal of Heart Failure 2006 8(5):494-501; doi:10.1016/j.ejheart.2005.11.013

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Prognostic importance of cognitive impairment in chronic heart failure patients: Does specialist management make a difference?

Skye N. McLennan^a, Sue A. Pearson^a, Janette Cameron^b and Simon Stewart^a^,c^,*

^a University of South Australia, Division of Health Science Australia
^b Deakin University, School of Nursing Australia
^c Division of Health Science, University of Queensland, School of Medicine Australia

^* Corresponding author. School of Nursing and Midwifery, University Of South Australia, City East Campus, North Terrace, Adelaide, SA 5000, Australia. Tel.: +61 08 8302 1115, +61 04 3830 2111 (Mobile); fax: +61 08 8302 2337. E-mail address: simon.stewart{at}unisa.edu.au

Abstract

Background: Cognitive impairment is common among chronic heart failure (CHF)patients.

Aims: To determine the prognostic significance of cognitive impairmentin patients participating in a randomized study of a CHF managementprogram (CHF-MP).

Methods: CHF patients were randomized to a CHF-MP (n=100) or usual care(n=100). Baseline cognition was assessed using the Mini MentalStatus Examination (MMSE). Five-year all-cause mortality, andcombined death-or-readmission, were compared on the basis ofthe presence (MMSE 19–26) or absence (MMSE >26) ofcognitive impairment.

Results: 27 patients (13.5%) had cognitive impairment and, on an adjustedbasis, were more likely to die (96.3% versus 68.2%. RR 2.19,95% CI 1.41 to 3.39: P<0.001) and/or experience an unplannedhospitalization (100% versus 94%. RR 1.44, 95% CI 1.06 to 1.95:P=0.019). Cognitively impaired patients had a similar (non-significant)adjusted risk of death-or-readmission in both the CHF-MP (RR1.40, 95% CI 0.63 to 3.11: P=0.403) and in usual care (RR 1.38,95% CI 0.75 to 2.53: P=0.305). In the usual care cohort, cognitiveimpairment was associated with a greater (non-significant),adjusted risk of death (RR 1.61, 95% CI 1.10 to 4.92: P=0.122).In the CHF-MP, adjusted risk of death was significantly higherfor cognitively impaired patients (RR 2.33, 95% CI 1.10 to 4.92:P=0.027).

Conclusion: These data suggest that "mild" cognitive impairment is of prognosticimportance in CHF: even when a CHF-MP has been applied.

Key Words: Chronic heart failure • Cognitive impairment • Prognosis • Management

Received June 4, 2005; Revised September 3, 2005; Accepted November 10, 2005

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