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Public Health
Manabu Kokubo1, Akihiro Hirashiki2, Takahiro Kamihara2
1The National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.
Insights
Elderly heart failure patients with dementia have a similar prognosis to those without cognitive impairment. Advances in heart failure treatment appear to improve outcomes for both groups, reducing rehospitalization and mortality risks.
Area of Science:
- Geriatric Medicine
- Cardiology
- Neurology
Background:
- Cognitive impairment is common in elderly patients with heart failure.
- Dementia in heart failure patients is associated with increased rehospitalization and mortality.
- Advances in heart failure pharmacotherapy have improved prognosis over two decades.
Purpose of the Study:
- To evaluate if recent heart failure treatment advancements have improved prognosis in elderly patients with cognitive impairment.
- To compare the prognosis of elderly heart failure patients with and without dementia.
Main Methods:
- Retrospective study of 80-89 year olds hospitalized for heart failure (2018-2021).
- Patients divided into dementia and non-dementia groups.
- Three-year follow-up for rehospitalization and mortality.
Main Results:
- 85 patients included (35 dementia, 50 non-dementia).
- No significant differences in background, complications, or medications between groups.
- No significant differences in 3-year rehospitalization or mortality between dementia and non-dementia groups.
Conclusions:
- Elderly heart failure patients with dementia showed a prognosis comparable to those without dementia.
- This suggests that current heart failure treatments may mitigate the negative impact of cognitive impairment on outcomes.
Background:
Elderly patients with heart failure frequently suffer from cognitive impairment. It is generally believed that patients with heart failure and dementia are more likely to experience events such as rehospitalization and death than those without dementia. On the other hand, drug treatment for heart failure has continued to advance for over 20 years, improving the prognosis. In this study, we aimed to determine whether such advances in treatment methods have improved the prognosis of elderly patients with heart failure and cognitive impairment.
Method:
This retrospective study targeted patients aged 80 to 89 years who were hospitalized for the first time for heart failure between 2018 and 2021. They were divided into dementia and non-dementia group, and were followed up for three years to investigate the occurrence of events such as rehospitalization and death (Approval no. 1272).
Result:
There were 85 cases that met the criteria for this study (35 in the dementia group and 50 in the non-dementia group). The age at first hospitalization for heart failure tended to be higher in the dementia group, but the difference was not significant (dementia group 85.0±3.1, non-dementia group 83.8±3.5, p = 0.09). There were no significant differences between the two groups in terms of patient background, such as gender ratio, complications, or number of medications being taken. In addition, hypertension and atrial fibrillation were common as underlying diseases in both groups. In the non-dementia group, 82% had heart failure with preserved ejection fraction (HFpEF), while in the dementia group, 69% had HFpEF and the proportion of heart failure with reduced systolic function (HFrEF) was increasing (p = 0.025). There were no significant differences between the two groups in re-hospitalization due to recurrent heart failure and total mortality during the 3-year follow-up period (long-rank p = 0.31, long-rank p = 0.77).
Conclusion:
The three-year follow-up in this study suggested that the prognosis of elderly patients with heart failure and dementia was almost equivalent to that of elderly patients with heart failure without dementia.
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