Risk evaluation of cognitive impairment in patients with heart failure: A call for action

Area of Science:

• Cardiology
• Neurology
• Geriatrics

Background:

• Cognitive impairment (CI) is prevalent in heart failure (HF) patients, affecting treatment adherence and quality of life.
• Early recognition of CI in HF is crucial for effective patient management.
• Developing a reliable risk model for CI in HF can aid in identifying at-risk individuals.

Purpose of the Study:

• To develop and validate a risk prediction model for cognitive impairment in patients with heart failure.
• To identify easily accessible patient characteristics that predict cognitive impairment in HF.
• To assess the model's performance in an independent validation cohort.

Main Methods:

• A risk model was developed using data from 611 patients aged ≥60 years with HF from the TIME-CHF trial.
• Least-absolute-shrinkage-and-selection-operator (LASSO) regression identified predictors: older age, female sex, NYHA class III/IV, Charlson comorbidity index ≥6, anemia, heart rate ≥70 bpm, and systolic blood pressure ≥145 mmHg.
• The model was validated in 155 patients aged ≥60 years with HF from the ECHO study.

Main Results:

• The initial model showed a c-statistic of 0.70 (0.63-0.78) for predicting CI.
• In the validation cohort, 33% of patients had CI.
• External validation yielded an AUC of 0.56 (0.46-0.66), indicating poor predictive performance.

Conclusions:

• The developed risk model demonstrated poor predictive performance upon external validation, potentially due to case-mix variation.
• These findings emphasize the necessity of active screening and standardized cognitive assessments for heart failure patients.
• Further research is needed to refine CI prediction in the HF population.