Many more elderly patients with heart failure have cognitive impairment than their treating cardiologists realize, a recent study found.
Researchers at multiple sites in France studied 912 ambulatory heart failure patients age 70 or above treated by cardiologists between January and November 2009. On average, the patients' heart failure had been diagnosed 4.4 years earlier and mean ejection fraction was 43.6%. Patients in the study were given the delayed recall Memory Impairment Screen (MIS-D). Results were published online by the American Journal of Cardiology in January.
The 291 participating cardiologists suspected that 109 patients (12% of the total) had memory impairment. However, results on the MIS-D revealed that 45.6% of the patients had memory impairment (95% CI, 42.4% to 48.8%) and 23.4% had severe memory impairment (95% CI, 20.6% to 26.1%). The study found an association between greater memory impairment and more severe heart failure class. However, this finding was no longer significant when adjusted for older age, lower education level, depression, history of stroke, renal failure and less physical activity (all independent predictors of impairment).
Researchers concluded that memory impairment is common among older patients with heart failure and that screening tools such as the MIS-D could help identify patients at risk. Identification of these patients is important because management of their disease requires “complex pharmacological therapy, diet and fluid restrictions, monitored physical activity and patient education that can be difficult to understand, remember and manage for patients with cognitive impairment,” the authors wrote.
The mechanism for the association between impairment and heart failure is not known, the study authors said, although they offered 3 possibilities: common risk factors such as hypertension, diabetes or dyslipidemia; focal brain vascular lesions or chronic ischemia; and decreased cardiac output leading to inadequate cerebral perfusion. Regardless of the cause, better identification of impairment could allow physicians to take steps (such as pill boxes or nurse visits) to improve heart failure patients' ability to care for themselves.