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Long-Term Cognitive Decline After Newly Diagnosed Heart Failure: Longitudinal Analysis in the CHS (Cardiovascular
Christa A Hammond1, Natalie J Blades1, Sarwat I Chaudhry1
1From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA.
Insights
Heart failure (HF) diagnosis is linked to faster cognitive decline. This accelerated cognitive aging occurs regardless of atrial fibrillation or ejection fraction status, highlighting a critical public health concern.
Area of Science:
- Cardiology
- Neurology
- Gerontology
Background:
- Heart failure (HF) is recognized to be associated with cognitive impairment.
- Limited understanding exists regarding the temporal dynamics of cognitive changes post-HF diagnosis, the influence of comorbid atrial fibrillation, and the role of ejection fraction.
- The study addresses these knowledge gaps by investigating the relationship between incident HF and cognitive decline rates.
Purpose of the Study:
- To determine the association between incident heart failure (HF) and the rate of cognitive decline.
- To investigate whether this association differs based on the presence of atrial fibrillation.
- To examine if the association varies between patients with reduced versus preserved ejection fraction.
Main Methods:
- Utilized data from 4864 participants (aged ≥65) in the Cardiovascular Health Study (CHS), a prospective US cohort study.
- Identified 496 participants with incident HF through hospital discharge summaries and Medicare claims, with annual cognitive assessments using the Modified Mini-Mental State Examination (MMSE).
- Employed adjusted statistical models to compare 5-year cognitive decline in individuals with and without incident HF, analyzing subgroups by atrial fibrillation and ejection fraction status.
Main Results:
- Incident HF was associated with a significantly faster 5-year decline in global cognitive ability (10.2 MMSE points) compared to individuals without HF (5.8 MMSE points).
- The accelerated cognitive decline post-HF diagnosis was observed to be more pronounced at older ages.
- The association between HF and cognitive decline did not significantly differ based on atrial fibrillation status (P=0.084) or ejection fraction (P=0.734).
Conclusions:
- Cognitive ability tends to decline more rapidly following a heart failure diagnosis compared to individuals without HF.
- These findings underscore the clinical and public health implications of accelerated cognitive decline in the HF population.
- Further research and attention are warranted to address the cognitive consequences of heart failure.
Background:
Heart failure (HF) is associated with cognitive impairment. However, we know little about the time course of cognitive change after HF diagnosis, the importance of comorbid atrial fibrillation, or the role of ejection fraction. We sought to determine the associations of incident HF with rates of cognitive decline and whether these differed by atrial fibrillation status or reduced versus preserved ejection fraction.
Methods And Results:
Participants were 4864 men and women aged ≥65 years without a history of HF and free of clinical stroke in the CHS (Cardiovascular Health Study)-a community-based prospective cohort study in the United States, with cognition assessed annually from 1989/1990 through 1998/1999. We identified 496 participants with incident HF by review of hospital discharge summaries and Medicare claims data, with adjudication according to standard criteria. Global cognitive ability was measured by the Modified Mini-Mental State Examination. In adjusted models, 5-year decline in model-predicted mean Modified Mini-Mental State Examination score was 10.2 points (95% confidence interval, 8.6-11.8) after incident HF diagnosed at 80 years of age, compared with a mean 5-year decline of 5.8 points (95% confidence interval, 5.3-6.2) from 80 to 85 years of age without HF. The association was stronger at older ages than at younger ages, did not vary significantly in the presence versus absence of atrial fibrillation (P=0.084), and did not vary significantly by reduced versus preserved ejection fraction (P=0.734).
Conclusions:
Decline in global cognitive ability tends to be faster after HF diagnosis than without HF. Clinical and public health implications of this finding warrant further attention.
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