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Factors contributing to global cognitive impairment in heart failure: results from a population-based cohort
Patrick M Pullicino1, Virginia G Wadley, Leslie A McClure
1Kent Institute of Medicine and Health Sciences, University of Kent, Canterbury, Kent, United Kingdom.
Insights
Heart failure (HF) and cognitive impairment in older adults are linked, but this association is explained by demographic factors, socioeconomic status, and comorbidities like depression. Screening for anemia and depression is recommended for those with HF and cognitive issues.
Area of Science:
- Gerontology
- Cardiology
- Neurology
Background:
- Heart failure (HF) and cognitive impairment are prevalent conditions in the elderly population.
- The relationship between HF and cognitive impairment requires further investigation.
Purpose of the Study:
- To investigate the association between very probable heart failure and cognitive impairment in a large cohort of older adults.
- To determine the influence of demographic, socioeconomic, behavioral, and comorbidity factors on this relationship.
Main Methods:
- Utilized data from 14,089 participants in the Reasons for Geographic and Racial Differences in Stroke cohort.
- Assessed very probable heart failure via self-reported symptoms and cognitive impairment using the Six-item Screener.
- Employed univariate and multivariable regression models to analyze the association, adjusting for various covariates.
Main Results:
- Initially, very probable HF was associated with a 1.51-fold increased likelihood of cognitive impairment.
- After adjusting for covariates, the association was attenuated and no longer statistically significant.
- Demographic factors, Stroke Belt region, socioeconomic status, prior stroke, and depression remained significant predictors of cognitive impairment.
- Higher hemoglobin levels showed a modest inverse association with cognitive impairment odds.
Conclusions:
- The link between cognitive impairment and heart failure is largely explained by demographic, socioeconomic, and comorbidity factors.
- Depression and anemia are significant factors to consider in individuals with both HF and cognitive impairment.
- Screening for depression and anemia is recommended for individuals experiencing both heart failure and cognitive impairment.
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.
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