Association of Cognitive Impairment With Mortality and Readmission in Patients With Heart Failure: A Meta-analysis
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Hailing Zhang1, Yu Jie2, Yimeng Sun2
1Center of Clinical Medical Research, The Affiliated Suqian First People's Hospital of Xuzhou Medical University, Suqian, Jiangsu, China.
Insights
Cognitive impairment significantly increases mortality and readmission risk in heart failure patients. Assessing cognitive function aids in better risk stratification for heart failure management.
Area of Science:
- Cardiology
- Neurology
- Geriatrics
Background:
- Cognitive impairment is common in heart failure (HF) patients.
- Its prognostic impact on mortality and readmission requires further clarification.
Purpose of the Study:
- To evaluate the prognostic significance of cognitive impairment on all-cause mortality and hospital readmission in heart failure patients.
- To synthesize existing evidence through a meta-analysis.
Main Methods:
- Systematic literature search of PubMed and Embase databases up to August 5, 2022.
- Inclusion of 12 studies with 9556 heart failure patients and a follow-up exceeding 3 months.
- Meta-analysis of adjusted risk ratios for mortality and readmission.
Main Results:
- Prevalence of cognitive impairment in HF patients ranged from 13.5% to 63.4%.
- Cognitive impairment was associated with a 1.88-fold increased risk of all-cause mortality (RR 1.88, 95% CI 1.42-2.48).
- Increased risks were also observed for readmission (RR 1.48, 95% CI 1.19-1.84) and combined endpoints (RR 1.53, 95% CI 1.35-1.73).
Conclusions:
- Cognitive impairment is a significant independent predictor of adverse outcomes in heart failure.
- Routine assessment of cognitive function may enhance risk stratification and management strategies for HF patients.
Abstract:
Cognitive impairment is a frequent condition in patients with heart failure (HF). This meta-analysis aimed to evaluate the prognostic impact of cognitive impairment on all-cause mortality and readmission among HF patients. We systematically searched articles indexing in PubMed and Embase databases until August 5, 2022. Original studies investigating the association of cognitive impairment with mortality and/or readmission for more than 3-month follow-up in patients with HF were selected. Twelve studies including 9556 patients were eligible. The prevalence of cognitive impairment ranged from 13.5% to 63.4% in HF patients. For patients with cognitive impairment vs those without, the pooled adjusted risk ratio (RR) was 1.88 (95% confidence intervals [CI] 1.42-2.48) for all-cause mortality, 1.48 (95% CI 1.19-1.84) for readmission, and 1.53 (95% CI 1.35-1.73) for combined endpoints of all-cause mortality/readmission, respectively. Cognitive impairment is a significant predictor of all-cause mortality/readmission in patients with HF, even after adjustment for the conventional confounding. Evaluation of cognitive function may help to improve risk classification of HF patients.
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