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Differences in Pharmacological Treatment of Heart Failure Among Persons with or without Major Cognitive Disorder: A
Linda Rankin1, Sofia Svahn2, Jonas Kindstedt2
1Department of Medical and Translational Biology, Umeå University, Umeå, Sweden. linda.rankin@umu.se.
Insights
Heart failure patients with major neurocognitive disorder (NCD) receive less medication, including renin-angiotensin system (RAS) inhibitors and beta-blockers (BBs). This suggests potential undertreatment in this vulnerable population.
Area of Science:
- Cardiology
- Neurology
- Geriatrics
Background:
- Heart failure (HF) commonly co-occurs with cognitive impairment in older adults, affecting 40-50% of HF patients.
- Previous research indicates potential undertreatment of cardiovascular conditions in individuals with major neurocognitive disorder (NCD).
Purpose of the Study:
- To investigate differences in the pharmacological treatment of HF in patients with and without co-occurring major NCD.
Main Methods:
- Data were combined from three Swedish national registers: Patient Register, SveDem (cognitive/dementia disorders), and Prescribed Drug Register.
- Logistic regression analysis was employed to examine associations between drug use and major NCD, controlling for age, sex, and nursing home residency.
Main Results:
- Patients with major NCD showed lower prescription rates for renin-angiotensin system (RAS) inhibitors, beta-blockers (BBs), and mineralocorticoid receptor antagonists (MRAs).
- Nursing home residency correlated with reduced use of RAS inhibitors, BBs, digitalis glycosides, and SGLT2 inhibitors.
- Sex-based differences were observed, with females having higher odds of using BBs, loop diuretics, and digitalis glycosides, but lower odds for RAS inhibitors and SGLT2 inhibitors.
Conclusions:
- Findings suggest potential undertreatment of HF pharmacological therapies in patients with co-occurring major NCD.
- Major NCD is associated with reduced prescriptions of essential HF medications like RAS inhibitors, BBs, and MRAs.
- Further research is needed to explore the reasons behind this undertreatment and its implications.
Introduction:
Comorbidities are common among older people, and during the last decade, a strong association between heart failure (HF) and cognitive impairment has been found. As much as 40-50% of individuals with HF will also have some degree of cognitive impairment. Previous studies report an undertreatment for some cardiovascular diseases in patients with major neurocognitive disorder (NCD).
Objective:
The aim of this present study was to explore differences in pharmacological treatment of HF in individuals diagnosed with HF with or without comorbidity of major NCD.
Methods:
This study combined data from three different Swedish national registers: the Swedish National Patient Register, the Swedish registry for cognitive/dementia disorders (SveDem), and the Swedish Prescribed Drug Register. A logistic regression model including variables for age, sex, major NCD, and nursing home residency was used to analyze associations between drug use and major NCD.
Results:
We found a lower prevalence of filled prescriptions of renin-angiotensin system (RAS) inhibitors, β-blockers (BBs), and mineralocorticoid receptor antagonists (MRAs) among patients with major NCD. Living in a nursing home was associated with lower prevalence of RAS inhibitors, BBs, digitalis glycosides, and sodium-glucose cotransporter-2 (SGLT2) inhibitors. Females were found to have higher odds of using BBs, loop diuretics and digitalis glycosides, and lower odds of using RAS inhibitors and SGLT2 inhibitors than males.
Conclusion:
Our findings indicate that there is possible undertreatment among individuals with HF identified in specialized care with co-occurring major NCD. Major NCD was associated with less filled prescriptions of basal pharmacological treatments such as RAS inhibitors, BBs, and MRAs. Future research needs to not only investigate this relationship further but also focus on reasons for the undertreatment of HF and other comorbidities within this group.
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