Christa A Hammond1, Natalie J Blades1, Sarwat I Chaudhry1, John A Dodson1, W T Longstreth1, Susan R Heckbert1, Bruce M Psaty1, Alice M Arnold1, Sascha Dublin1, Colleen M Sitlani1, Julius M Gardin1, Stephen M Thielke1, Michael G Nanna1, Rebecca F Gottesman1, Anne B Newman1, Evan L Thacker2. 1. From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA. 2. From the Department of Statistics (C.A.H., N.J.B.) and Department of Public Health (E.L.T.), Brigham Young University, Provo, UT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT (S.I.C.); Department of Medicine (J.A.D.) and Department of Population Health (J.A.D.), New York University Langone Medical Center; Cardiovascular Health Research Unit (S.R.H., B.M.P., C.M.S.), Department of Neurology (W.T.L.), Department of Epidemiology (W.T.L., S.R.H., B.M.P., S.D.), Department of Medicine (B.M.P., C.M.S.), Department of Health Services (B.M.P.), Department of Biostatistics (A.M.A.), and Department of Psychiatry and Behavioral Sciences (S.M.T.), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (S.R.H., B.M.P., S.D.); Department of Medicine, Rutgers New Jersey Medical School, Newark (J.M.G.); Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, WA (S.M.T.); Department of Medicine, Duke University School of Medicine, Durham, NC (M.G.N.); Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.); and Department of Epidemiology (A.B.N.), Department of Medicine (A.B.N.), and Clinical and Translational Science Institute (A.B.N.), University of Pittsburgh, PA. elt@byu.edu.
Abstract
BACKGROUND: Heart failure (HF) is associated with cognitive impairment. However, we know little about the time course of cognitive change after HF diagnosis, the importance of comorbid atrial fibrillation, or the role of ejection fraction. We sought to determine the associations of incident HF with rates of cognitive decline and whether these differed by atrial fibrillation status or reduced versus preserved ejection fraction. METHODS AND RESULTS: Participants were 4864 men and women aged ≥65 years without a history of HF and free of clinical stroke in the CHS (Cardiovascular Health Study)-a community-based prospective cohort study in the United States, with cognition assessed annually from 1989/1990 through 1998/1999. We identified 496 participants with incident HF by review of hospital discharge summaries and Medicare claims data, with adjudication according to standard criteria. Global cognitive ability was measured by the Modified Mini-Mental State Examination. In adjusted models, 5-year decline in model-predicted mean Modified Mini-Mental State Examination score was 10.2 points (95% confidence interval, 8.6-11.8) after incident HF diagnosed at 80 years of age, compared with a mean 5-year decline of 5.8 points (95% confidence interval, 5.3-6.2) from 80 to 85 years of age without HF. The association was stronger at older ages than at younger ages, did not vary significantly in the presence versus absence of atrial fibrillation (P=0.084), and did not vary significantly by reduced versus preserved ejection fraction (P=0.734). CONCLUSIONS: Decline in global cognitive ability tends to be faster after HF diagnosis than without HF. Clinical and public health implications of this finding warrant further attention.
BACKGROUND:Heart failure (HF) is associated with cognitive impairment. However, we know little about the time course of cognitive change after HF diagnosis, the importance of comorbid atrial fibrillation, or the role of ejection fraction. We sought to determine the associations of incident HF with rates of cognitive decline and whether these differed by atrial fibrillation status or reduced versus preserved ejection fraction. METHODS AND RESULTS:Participants were 4864 men and women aged ≥65 years without a history of HF and free of clinical stroke in the CHS (Cardiovascular Health Study)-a community-based prospective cohort study in the United States, with cognition assessed annually from 1989/1990 through 1998/1999. We identified 496 participants with incident HF by review of hospital discharge summaries and Medicare claims data, with adjudication according to standard criteria. Global cognitive ability was measured by the Modified Mini-Mental State Examination. In adjusted models, 5-year decline in model-predicted mean Modified Mini-Mental State Examination score was 10.2 points (95% confidence interval, 8.6-11.8) after incident HF diagnosed at 80 years of age, compared with a mean 5-year decline of 5.8 points (95% confidence interval, 5.3-6.2) from 80 to 85 years of age without HF. The association was stronger at older ages than at younger ages, did not vary significantly in the presence versus absence of atrial fibrillation (P=0.084), and did not vary significantly by reduced versus preserved ejection fraction (P=0.734). CONCLUSIONS: Decline in global cognitive ability tends to be faster after HF diagnosis than without HF. Clinical and public health implications of this finding warrant further attention.
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