AT THE AHA SCIENTIFIC SESSIONS
NEW ORLEANS (FRONTLINE MEDICAL NEWS) – Elderly patients with heart failure had a significantly increased prevalence of both dementia and mild cognitive impairment, compared with similar people without heart failure, in an analysis of data collected from more than 6,000 U.S. residents enrolled in a long-term observational study.
Patients diagnosed with either heart failure with reduced ejection fraction or heart failure with preserved ejection fraction had an 89% increased prevalence of dementia and a 41% increased prevalence of mild cognitive impairment (MCI), compared with people from the same cohort who did not develop heart failure, in an analysis that adjusted for several demographic and clinical variables, Lucy S. Witt, MD, reported at the American Heart Association scientific sessions. She speculated that the link between heart failure and dementia and MCI might result from impaired cerebral perfusion in heart failure patients or from effects from heart failure medications.
“Our findings suggest that clinicians should have a higher suspicion for cognitive impairment in patients with heart failure, regardless of other, more classic risk factors,” she said in an interview. “This knowledge could prompt physicians to perform testing [for dementia and MCI], initiate conversations regarding the goals of care or advance care planning, and discuss appropriate living situations” for their patients with heart failure, said Dr. Witt, a researcher at the University of North Carolina in Chapel Hill.
The analysis used data collected for the Atherosclerosis Risk in Communities (ARIC) study, which began in 1987 and enrolled a randomly selected representative cohort of nearly 16,000 women and men aged 45-64 years old who resided in any of four U.S. communities. She specifically focused on the data collected from 6,431 of the participants who returned for a fifth follow-up examination during 2011-2013, including 5,490 people without heart failure, whose average age was 76 years, and 941 participants with heart failure, whose average age was 78 years.
Dementia prevalence at the fifth follow-up visit occurred at an adjusted rate of 5.6% among those without heart failure and 7.0% in those with heart failure. The examinations also found MCI in an adjusted 21.5% of those without heart failure and in 26.2% of those with heart failure, Dr. Witt reported. Adjustments included age, sex, location, education, hypertension, diabetes, depression, alcohol and tobacco use, cerebral vascular disease, marital status, and several other factors.
The relative risk for having dementia among the heart failure patients was roughly similar, regardless of whether ARIC participants with heart failure had a reduced or preserved left ventricular ejection fraction, she said.
ARIC is funded by the National Heart, Lung, and Blood Institute. Dr. Witt had no disclosures.
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