Elsevier

JACC: Heart Failure

Volume 7, Issue 12, December 2019, Pages 1042-1053
JACC: Heart Failure

Special Issue: Heart Failure in the Elderly
Clinical Research
Cognitive Decline Over Time in Patients With Systolic Heart Failure: Insights From WARCEF

https://doi.org/10.1016/j.jchf.2019.09.003Get rights and content
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Abstract

Objectives

This study sought to characterize cognitive decline (CD) over time and its predictors in patients with systolic heart failure (HF).

Background

Despite the high prevalence of CD and its impact on mortality, predictors of CD in HF have not been established.

Methods

This study investigated CD in the WARCEF (Warfarin versus Aspirin in Reduced Ejection Fraction) trial, which performed yearly Mini-Mental State Examinations (MMSE) (higher scores indicate better cognitive function; e.g., normal score: 24 or higher). A longitudinal time-varying analysis was performed among pertinent covariates, including baseline MMSE and MMSE scores during follow-up, analyzed both as a continuous variable and a 2-point decrease. To account for a loss to follow-up, data at the baseline and at the 12-month visit were analyzed separately (sensitivity analysis).

Results

A total of 1,846 patients were included. In linear regression, MMSE decrease was independently associated with higher baseline MMSE score (p < 0.0001), older age (p < 0.0001), nonwhite race/ethnicity (p < 0.0001), and lower education (p < 0.0001). In logistic regression, CD was independently associated with higher baseline MMSE scores (odds ratio [OR]: 1.13; 95% confidence interval [CI]: 1.07 to 1.20]; p < 0.001), older age (OR: 1.37; 95% CI: 1.24 to 1.50; p < 0.001), nonwhite race/ethnicity (OR: 2.32; 95% CI: 1.72 to 3.13 for black; OR: 1.94; 95% CI: 1.40 to 2.69 for Hispanic vs. white; p < 0.001), lower education (p < 0.001), and New York Heart Association functional class II or higher (p = 0.03). Warfarin and other medications were not associated with CD. Similar trends were seen in the sensitivity analysis (n = 1,439).

Conclusions

CD in HF is predicted by baseline cognitive status, demographic variables, and NYHA functional class. The possibility of intervening on some of its predictors suggests the need for the frequent assessment of cognitive function in patients with HF. (Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction [WARCEF]; NCT00041938)

Key Words

cognitive function
comorbidities
dementia
longitudinal analysis
Mini-Mental State Examination

Abbreviations and Acronyms

CD
cognitive decline
HF
heart failure
NYHA
New York Heart Association

Cited by (0)

The WARCEF trial was supported by U.S. National Institute of Neurological Disorders and Stroke (NINDS) grants U01-NS-043975 (to Dr. Homma) and U01-NS-039143 (to Dr. Thompson). Dr. Anker is a consultant for Bayer, Boehringer Ingelheim, Novartis, Stealth Peptides, Servier, Vifor, and Janssen; and has received research support from Abbott Vascular and Vifor. Dr. Homma is a consultant for St. Jude Medical, Daiichi-Sankyo, Bristol-Myers Squibb, and Pfizer. Dr. Labovitz has received research support from Bristol-Myers Squibb/Pfizer. Dr. Lip is a consultant for Bayer/Janssen, Bristol-Myers Squibb/Pfizer, Biotronik, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi-Sankyo; and is a speaker for Bayer, Bristol-Myers Squibb/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo. Dr. Sacco has received research support from grants from NINDS, National Center for Advancing Translational Sciences, American Heart Association, the Evelyn McKnight Brain Foundation, and Boehringer Ingelheim. Dr. Teerlink is a consultant for and has received research support from Actelion, Amgen, Bayer, Cytokinetics, Medtronic, Novartis, St. Jude Medical, and Trevena. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.