New research suggests that cognitive impairment could predict worse outcomes such as readmission to hospital or death in older heart failure patients.
The researchers found that a large proportion of heart failure patients in their study was also cognitively impaired.
According to the authors of the study, heart failure patients with cognitive impairment had a risk of all-cause death and heart failure readmission 7.5 times greater than those without cognitive impairment. The researchers suggest that this increase may in part be due to patients becoming worse at adhering to important courses of medication.
The findings of the study are being presented at Heart Failure 2015, the main annual meeting of the Heart Failure Association of the European Society of Cardiology (ESC). The event takes place in Seville, Spain, running from 23-26 May. The ESC represents over 80,000 cardiology professionals across Europe and the Mediterranean.
Heart failure, also referred to as congestive heart failure, is a chronic, progressive condition whereby the heart is unable to pump enough blood around the body to supply cells with blood and oxygen. The condition can lead to fatigue and shortness of breath, with severe cases leading to kidney and liver damage.
“Systematic reviews have shown that cognitive impairment is common in patients with chronic heart failure,” says Hiroshi Saito, a physiotherapist at Kameda Medical Centre in Kamogawa, Japan.
“However, the impact of cognitive impairment on the prognosis of heart failure patients is not known. Our study investigated whether cognitive impairment independently predicted the outcome of elderly patients with heart failure.”
For the study, Mr. Saito and colleagues assessed 136 heart failure patients aged 65 and over (average age of 82) who were admitted to the Kameda Medical Centre. Each patient completed the Mini Mental State Examination (MMSE) so that staff could evaluate the presence of any cognitive disorder prior to discharge.
Provision of disease management education for families is recommended
The researchers divided the patients into two separate groups based on the findings of the MMSE. A total of 101 patients (74%) scored below 27 on the MMSE and were classified as having cognitive disorder. The other participants that scored 27 and above were deemed to not have cognitive disorder.
During the follow-up period of 161 days, 33 patients (24%) were either readmitted to the hospital due to heart failure or had died.
Patients in the cognitive impairment group had a significantly worse prognosis than patients in the group without cognitive impairment. The 7.5-fold greater risk remained after the researchers adjusted their data for potential confounding factors such as age, body mass index and hemoglobin levels.
“We expect that heart failure patients with cognitive impairment tend to get progressively worse at adhering to medications,” Saito states. “It is possible that this could explain why they have a worse prognosis. Cardiologists and other medical staff should assess the cognitive status of elderly heart failure patients.”
Saito suggests that education on disease management should be provided for families when patients are found to have impaired cognitive status in order to reduce the chances of heart failure readmission.
Last month, Medical News Today reported on a study finding that patients who did not fully understand the health information given to them after heart failure – “not necessarily” due to their intelligence – were at a higher risk of death. More thorough education on disease management could well be the way forward.
“The three major components of this are medication, nutrition, and exercise,” explains Saito. “Of these three components, medication is an especially important element. It is necessary for families to enhance medication adherence for patients who are unable to manage their medication by themselves.”
At present, there are no specific treatments to be given for cognitive impairment in heart failure patients, although exercise is often recommended to those who do not have shortness of breath from their most recent episode of heart failure.
“Clinicians need to be more aware of the cognitive status of their heart failure patients and families can play an important role in ensuring that patients take their medication, get some exercise and eat well,” Saito concludes.