Physicians' Academy for Cardiovascular Education

Memory impairment in heart failure patients much more prevalent than cardiologists think

Literature - Hanon O et al. Am J Cardiol 2014 - Am J Cardiol 2014

 
Prevalence of Memory Disorders in Ambulatory Patients Aged 70 Years and Older With Chronic Heart Failure (from the EFICARE Study)

 
Hanon O, Vidal J-S, De Groote P, et al.
Am J Cardiol 2014. Online January 16, 2014
 

Background

The relation between heart failure (HF) and memory disorders remains controversial [1-5], although both conditions primarily affect the elderly.
The Evaluation of risk Factors for cognitive Impairment in Chronic Ambulatory heart failuRe in the Elderly (EFICARE) study aims to assess the usability of the Memory Impairment Screen (MIS) test by cardiologists. The prevalence and determinants of memory impairment is assessed in a large ambulatory population of subjects >70 years old with symptomatic HF in France. Furthermore, this study aims to compare the cardiologist’s clinical global impression with use MIS for screening of memory disorders. Cardiologists were first asked to rate their patient’s cognitive function as normal or impaired, before they would do a delayed-recall MIS (MIS-D). Maximum score in MIS-D is 8, <6 means impaired memory function and <4 implies severe impairment. 912 subjects were included.
 

Main results

  • As compared to patients with MIS-D[7-8], subjects with MIS-D[0-6] were older, more often female, had with a lower educational level. They more often had renal failure, a history of stroke, depression and >1 fall in the past year and less likely to be physically active. Level of functional impairment (IADL score) was strongly associated with MID-D.
  • Impaired MIS-D (score 0-6) was seen in 45.6% (n=416, 95%CI: 42.4-48.8), and 23.4% (95%CI: 20.6-26.1) of subjects had MIS-D[0-4], thus severe memory impairment.
    Cardiologists suspected cognitive impairment in only 109 subjects (12%) before the cognitive evaluation, 34% of whom had MIS-D[0-4].
  • Severity of HF, as judged by NYHA classification, increased with decreasing MIS-D score. No relationships were seen between MIS-D groups and underlying causes of HF, such as blood pressure and left ventricular ejection fraction, but marginal differences were seen in mean heart rate between the MIS-D categories.
  • Subjects with MIS-D[0-6] but who were judged to be cognitively normal by cardiologists were younger and with less functional impairment and a less severe overall condition, as compared to those perceived to have cognitive impairment.

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Conclusion

In this large sample of community-dwelling HF patients of over 70 years old, almost half had memory impairment as measured with MIS-D. Cardiologists considered only 12% of these individuals to have memory impairment. Severity of memory impairment was inversely correlated to severity of HF.
Since the prevalence of cognitive impairment in the general older population ranges from 10-25%, it appears as though HF increases the risk of cognitive impairment.
It is important to act to decrease this underrecognition of memory impairment, as it may imply drug and lifestyle compliance in these patients.
 
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References

1. Vogels RLC, Oosterman JM, van Harten B, et al. Profile of cognitive impairment in chronic heart failure. J Am Geriatr Soc 2007;55: 1764e1770.
2. Zuccala G, Onder G, Pedone C, et al. Cognitive dysfunction as a major determi- nant of disability in patients with heart failure: results from a multi- centre survey. On behalf of the GIFA (SIGG-ONLUS) Investigators. J Neurol Neurosurg Psychiatry 2001;70:109e112.
3. Trojano L, Antonelli Incalzi R, Acanfora D, et al. Cognitive impairment: a key feature of congestive heart failure in the elderly. J Neurol 2003;250:1456e1463.
4. Qiu C, Winblad B, Marengoni A, et al. Heart failure and risk of dementia and Alzheimer disease: a population- based cohort study. Arch Intern Med 2006;166:1003e1008.
5. Okonkwo OC, Cohen RA, Gunstad J, et al. Longitudinal trajectories of cognitive decline among older adults with cardiovascular disease. Cerebrovasc Dis 2010;30:362e373.
 

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