Cognitive Impairments in Chronic Heart Failure: A Case Controlled Study

doi:10.1016/j.cardfail.2008.08.007

Journal of Cardiac Failure

Volume 15, Issue 1, February 2009, Pages 1-10

https://doi.org/10.1016/j.cardfail.2008.08.007 Get rights and content

Abstract

Background

There are limited data describing the prevalence, type, and severity of cognitive impairments (CIs) in the general population with chronic heart failure (HF). The primary purpose of this study was to fill this gap in the literature by comparing the cognitive function of patients with chronic HF and community-dwelling control subjects.

Methods and Results

A case controlled design was used. Fifty patients with HF were recruited and matched to 50 healthy control subjects on age (± 3 years), gender, and estimated intelligence (intelligence quotient ± 1 standard deviation). In the patient sample, mean left ventricular ejection fraction was 27% ± 14%, 22 patients had New York Heart Association (NYHA) class II, 23 patients had NYHA class III, and 5 patients had NYHA class IV heart disease. Neuropsychologic tests assessed cognitive outcomes in orientation, attention, memory, executive function, motor speed, and reaction times. Patients had significantly poorer scores than controls on 14 of 19 variables assessed. After standardization of the neuropsychologic test scores to T-scores (mean 50 ± 10 SD), 23 patients (46%) had mild to severe CI and 8 of the control subjects had mild CI. Both patients and controls were impaired in 1 or more of the 4 memory outcomes assessed. Logistic regression analysis indicated CI was independently associated with HF (odds ratio = 4.47, confidence interval = 1.75–11.43, P < .002). Severity of CI was associated with depressed learning (P < .0001), previous myocardial infarction (MI) (P < .02), and the number of MIs (P < .01). CI severity was not associated with LVEF, HF duration, NYHA class, anxiety, depression, positive affect, social support, or physical functioning. Severity of MI (≥2 MIs) was associated with deficits in early recall (P < .01), delayed recall (P < .03), and learning (P < .03). In contrast, patients with idiopathic or hypertensive cardiomyopathies without coronary artery disease when compared with patients with greater MI severity were not cognitively impaired on these outcome variables.

Conclusion

The prevalence, type, and severity of CI in the community-dwelling patients with HF are consistent with the results found in patients with end-stage HF awaiting heart transplantation. Patients with heart failure incur a more than 4-fold risk for CI compared with matched community controls. The relationship of MI severity to deficits in memory outcomes and learning suggests that ischemic cardiomyopathy may be a significant factor in the development of CI in heart failure.

Section snippets

Materials and Methods

A case controlled design was used to compare the patterns of cognitive function in a sample of patients with chronic HF and matched community-dwelling control subjects. A battery of neuropsychologic tests, including 3 that were computer based that allowed millisecond-measurement of reaction times, were used to assess cognitive function. Chart reviews, interviews, and standardized questionnaires were used to gather demographic, clinical, and psychologic data on the patient subjects. Similar

Results

The demographic and clinical characteristics of the patient and control samples are presented in Table 2. The majority of patients were white (78%), unmarried (62%), and retired or disabled (84%). Their mean LVEF was 27% ± 14%, and 22 had NYHA class II, 23 had NYHA class III, and 5 had NYHA class IV heart disease. The average duration of HF was 4.8 ± 5.1 years with a median duration of 3 years and a range of 6 months to 17 years. Twelve patients (24%) had undergone 1 or more coronary artery

Discussion

The prevalence of CIs in this sample of patients with chronic HF was 46%. These results are within the 30% to 84% range reported by other investigators using neuropsychologic test batteries to assess cognitive function in patients before heart transplantation.8, 17, 36, 54 In addition, the most frequent deficits found in these community-dwelling patients, as in patients pretransplant, were in memory, attention, problem solving, prolonged response times, and greater response variability.7, 17, 18

Conclusions

Despite the limitations of this case controlled study, the results indicate that the prevalence, type, and severity of CIs in patients with chronic HF living in the community are not significantly different from patients awaiting heart transplant. More important, the findings indicate that HF is an independent correlate of CIs and that HF increases the risk of CI more than 4 times compared with matched controls who do not have HF. Equally significant, these data also suggest that ischemic

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Health literacy is associated with heart failure (HF) care and outcomes. Online resources offer important educational materials for patients seeking access to heart transplantation but tend to be complex and potentially ineffective for non-English speakers and those with low reading levels. The purpose of this study was to evaluate both the readability of patient-level information posted on United States heart transplant center websites and the availability of non-English resources.
We performed a review of patient-facing information on websites of U.S. heart transplant centers identified through the United Network for Organ Sharing in August 2022. Written English text was extracted and assessed for readability by using the Fry Graph Readability score. Websites were additionally evaluated for non-English language text and translator tools. Standard ANOVA analysis was used to compare readability levels across transplant regions. The median Fry readability level to understand a piece of text for all regions was 15, which is equivalent to a college-junior reading level (range: 7–17, 7th grade to postgraduate level). There was no statistical difference in median Fry readability levels among regions (P = 0.16). Of the 139 eligible heart transplant center websites, only 56.1% (78/139) had non-English resources available for patients. Regions 5 (75% [15/20]) and 6 (75% [3/4]) had the highest percentage of non-English resources, and region 2 had the lowest (38% [6/16]).
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Citation Excerpt :
After reviewing the full text of these 165 studies, those that did not report the incidence or prevalence of cognitive impairment or dementia were excluded. We eventually included 119 studies in our systematic review and meta-analysis1–4,15,17,21,23,29–40,41–60,61–80,81–100,101–120,121–139. The Preferred Reporting Items for Systemic Review and Meta-Analysis (PRISMA) flowchart is presented in Fig. 1.
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Clinical InvestigationsCognitive Impairments in Chronic Heart Failure: A Case Controlled Study

Abstract

Background

Methods and Results

Conclusion

Section snippets

Materials and Methods

Results

Discussion

Conclusions

J Thorac Cardiovasc Surg

Int J Cardiol

Am J Cardiol

Arch Gerontol Geriatr

J Card Fail

Arch Gerontol Geriatr

Neuropsychologia

Arch Med Res

J Card Fail

Am J Cardiol

Neuroscience

Neurologic complications after coronary artery bypass grafting

J Cardiovasc Nurs

Neurophysiological sequalae of cardiac arrest

JAMA

Factors associated with cognitive recovery after cardiopulmonary resuscitation

Am J Crit Care

Cardiac arrest: long-term cognitive and imaging analysis

Resuscitation

Psychological and cognitive status before and after heart transplantation

Gen Hosp Psychiatry

Neuropsychological function in patients with end-stage heart failure before and after cardiac transplantation

Acta Neurol Scand

Neuropsychological functioning among heart transplant candidates

J Clin Exp Neuropsychol

The epidemiology of heart failure

Eur Heart J

Research recommendations for cardiovascular aging research

J Am Geriatr Soc

Congestive heart failure and cognitive impairment in an older population

J Am Geriatr Soc

Left ventricular dysfunction: a clue to cognitive impairment in older patients with heart failure

J Neurol Neurosurg Psychiatry

Gifa-Onlus Study Group. Hypotension and cognitive impairment. Selective association in patients with heart failure

Neurology

Cerebral blood flow in patients with chronic heart failure before and after heart transplantation

Stroke

Transcranial Doppler assessment of cerebral blood flow: effect of cardiac transplantation

Neurology

Cerebrovascular reactivity is impaired in patients with cardiac failure

Eur Heart J

Psychosocial, neuropsychological and neurological status in a sample of heart transplant recipients

Q Life Res

Cognitive function in patients with symptomatic dilated cardiomyopathy before and after cardiac transplantation

J Am Coll Cardiol

Verbal learning in cardiac transplant candidates: a preliminary report

Int J Rehabil Health

Memory improvement following cardiac transplantation

J Clin Exp Neuropsychol

Cyclosporine may affect improvement of cognitive brain function after successful cardiac transplantation

Circulation

Congestive heart failure and cognitive function amongst older adults

Arq Neuropsiquiatr

Clinical Investigations
Cognitive Impairments in Chronic Heart Failure: A Case Controlled Study