Tetz C Lee1, Min Qian1, Yutong Liu1, Susan Graham2, Douglas L Mann3, Koki Nakanishi1, John R Teerlink4, Gregory Y H Lip5, Ronald S Freudenberger6, Ralph L Sacco7, Jay P Mohr1, Arthur J Labovitz8, Piotr Ponikowski9, Dirk J Lok10, Kenji Matsumoto1, Conrado Estol11, Stefan D Anker12, Patrick M Pullicino13, Richard Buchsbaum1, Bruce Levin1, John L P Thompson1, Shunichi Homma1, Marco R Di Tullio14. 1. Columbia University Medical Center, New York, NY. 2. Department of Medicine, State University of New York at Buffalo, Buffalo, New York. 3. Department of Medicine, Washington University School of Medicine, St. Louis, Missouri. 4. Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, California. 5. Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. 6. Lehigh Valley Hospital, Allentown, Pennsylvania. 7. Department of Neurology, University of Miami, Miami, Florida. 8. Department of Medicine, University of South Florida, Tampa, Florida. 9. Military Hospital, Wroclaw, Poland. 10. Deventer Hospital, Deventer, the Netherlands. 11. Stroke Unit, Sanatorio Guemes, Buenos Aires, Argentina. 12. Division of Cardiology and Metabolism, Department of Cardiology, and Berlin-Brandenburg Center for Regenerative Therapies, Deutsches Zentrum für Herz-Kreislauf-Forschung partner site Berlin; Charité Universitätsmedizin Berlin, Germany; Department of Cardiology and Pneumology, University Medicine Göttingen, Göttingen, Germany. 13. Kent Institute of Medicine and Health Science, Canterbury, United Kingdom. 14. Columbia University Medical Center, New York, NY. Electronic address: md42@cumc.columbia.edu.
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).
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).
Authors: Anna Frey; György A Homola; Carsten Henneges; Larissa Mühlbauer; Roxane Sell; Peter Kraft; Maximilian Franke; Caroline Morbach; Marius Vogt; Wolfgang Müllges; Georg Ertl; László Solymosi; Lukas Pirpamer; Reinhold Schmidt; Mirko Pham; Stefan Störk; Guido Stoll Journal: Eur Heart J Date: 2021-04-21 Impact factor: 29.983
Authors: Fang Qin Goh; William K F Kong; Raymond C C Wong; Yao Feng Chong; Nicholas W S Chew; Tiong-Cheng Yeo; Vijay Kumar Sharma; Kian Keong Poh; Ching-Hui Sia Journal: Biology (Basel) Date: 2022-01-23
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