Cognitive dysfunction as a major determinant of disability in patients with heart failure: results from a multicentre survey

Cognitive dysfunction is a frequent finding among older patients with left ventricular systolic dysfunction; however, the clinical outcomes of such a finding are unknown. Also, disability is a common condition in heart failur e, poorly responding to commonly used cardiovascular medications. The association between cognitive dysfunction and disability was assessed i n 1583 patients with heart failure, but without cerebrovascular disease, pr evious stroke, or Alzheimer's disease, who were enrolled during 2 years of a multicentre pharmacoepidemiology survey. The association between groups o f variables (demographics, comorbid conditions, medications, and objective tests, including the Hodkinson abbreviated mental test) and functional disa bility (as indicated by need for intensive assistance in at least one of Ka tz' activities of daily living) was first analysed using separate age and s ex adjusted logistic regression models. Those variables, significant at a p <0.1 level in these models, were simultaneously entered into an age and sex adjusted summary regression model. Among 1583 patients suitable for analys is, cognitive dysfunction (as detected by abbreviated mental test score <7) was detected in 265/461 disabled patients, and in 150/1122 independent sub jects (p<0.0001). According to logistic regression analysis, cognitive dysf unction was associated with disability (OR=6.49; 95% CI=4.39-9.59) after ad justing for potential confounders. Thus, cognitive dysfunction in patients with heart failure is independently associated with disability, which curre ntly represents an overwhelming medical and financial problem to patients, caregivers, and public health services. As early recognition and treatment of low cardiac output states might reverse cognitive dysfunction, cost effe ctive treatment for heart failure should include systematic diagnostic and therapeutic approaches to cognitive dysfunction.