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Cognitive Decline Over Time in Patients With Systolic Heart Failure: Insights From WARCEF
Tetz C Lee1, Min Qian1, Yutong Liu1
1Columbia University Medical Center, New York, NY.
Insights
Cognitive decline in heart failure patients is linked to higher baseline cognitive scores, older age, nonwhite race, and lower education. Frequent cognitive assessments are recommended for heart failure patients.
Area of Science:
- Cardiology
- Neurology
- Geriatrics
Background:
- Cognitive decline (CD) is prevalent in heart failure (HF) patients and impacts mortality.
- Predictors of CD in HF remain largely unestablished, necessitating further investigation.
Purpose of the Study:
- To characterize the progression of cognitive decline over time in patients with systolic heart failure.
- To identify key predictors associated with cognitive decline in this population.
Main Methods:
- Analysis of data from the Warfarin versus Aspirin in Reduced Ejection Fraction (WARCEF) trial.
- Longitudinal time-varying analysis using yearly Mini-Mental State Examinations (MMSE) scores.
- Inclusion of baseline MMSE, demographic variables, and New York Heart Association (NYHA) functional class as covariates.
Main Results:
- Cognitive decline was independently associated with higher baseline MMSE scores, older age, nonwhite race/ethnicity, and lower education levels.
- New York Heart Association functional class II or higher also predicted cognitive decline.
- Warfarin and other medications showed no association with cognitive decline.
Conclusions:
- Baseline cognitive status, demographic factors, and NYHA functional class are significant predictors of cognitive decline in HF patients.
- The identified predictors suggest that interventions may be possible, highlighting the importance of regular cognitive function assessment in HF management.
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).
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