Incidence of Dementia and Subsequent Outcomes in Patients With Heart Failure

Dementia and heart failure (HF) frequently coexist; however, the relationship between these conditions is not fully explored.

The objectives of the study were to: 1) compare dementia incidence in newly-diagnosed patients with HF or matched non-HF controls; and 2) examine risk factors for and outcomes after dementia diagnosis in HF patients.

In community-dwelling residents (aged 40-80 years), we compared incident dementia in those with new-onset HF vs age/sex, and cardiovascular risk factor/disease-matched non-HF controls. In those with HF, we examined time-varying dementia onset as the exposure with outcomes of mortality and hospitalization. We also compared physician visits after vs before dementia diagnosis.

Among 211,548 outpatients with HF (median 68 [60-75] years, 41.2% female), time-dependent HRs for dementia were 1.42 (95% CI: 1.38-1.47) at 5 years and 1.31 (95% CI: 1.27-1.35) at 10 years compared to non-HF controls. Prior stroke or transient ischemia attack (HR: 1.41; 95% CI: 1.33-1.50) and hospital frailty risk score >10 vs <5 (HR: 1.93; 95% CI: 1.77-2.09) were important predictors of dementia (both P < 0.001). Incident dementia was associated with higher multivariable-adjusted hazards of all-cause mortality (HR: 2.44; 95% CI: 2.40-2.49) and all-cause hospitalization (HR: 1.63; 95% CI: 1.58-1.69) in outpatients with HF (all P < 0.001). Rates of outpatient physician visits with primary care, internal medicine, cardiologists (post/pre-rate ratio range 1.08-1.19), and geriatricians (post/prerate ratio 10.70; all P < 0.001) were higher after (versus before) dementia onset.

Incident HF was associated with higher risk of incident dementia. Dementia onset was associated with higher rates of outpatient physician visits and increased risk of adverse outcomes.