Dataset Information

Cognitive Decline Over Time in Patients With Systolic Heart Failure: Insights From WARCEF.

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).

SUBMITTER: Lee TC

PROVIDER: S-EPMC6944056 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Cognitive Decline Over Time in Patients With Systolic Heart Failure: Insights From WARCEF.

Lee Tetz C TC Qian Min M Liu Yutong Y Graham Susan S Mann Douglas L DL Nakanishi Koki K Teerlink John R JR Lip Gregory Y H GYH Freudenberger Ronald S RS Sacco Ralph L RL Mohr Jay P JP Labovitz Arthur J AJ Ponikowski Piotr P Lok Dirk J DJ Matsumoto Kenji K Estol Conrado C Anker Stefan D SD Pullicino Patrick M PM Buchsbaum Richard R Levin Bruce B Thompson John L P JLP Homma Shunichi S Di Tullio Marco R MR

JACC. Heart failure 20191201 12

<h4>Objectives</h4>This study sought to characterize cognitive decline (CD) over time and its predictors in patients with systolic heart failure (HF).<h4>Background</h4>Despite the high prevalence of CD and its impact on mortality, predictors of CD in HF have not been established.<h4>Methods</h4>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 cognitiv ...[more]

PMID: 31779926

Similar Datasets

Project description:Previous studies in patients with atrial fibrillation showed that a history of heart failure (HF) could negatively impact anticoagulation quality, as measured by the average time in therapeutic range (TTR). Whether additional markers of HF severity are associated with TTR has not been investigated thoroughly. We aimed to examine the potential role of HF severity in the quality of warfarin control in patients with HF with reduced ejection fraction. Data from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction Trial were used to investigate the association between TTR and HF severity. Multivariable logistic regression models were used to examine the association of markers of HF severity, including New York Heart Association (NYHA) class, Minnesota Living with HF (MLWHF) score, and frequency of HF hospitalization, with TTR ≥70% (high TTR). We included 1,067 participants (high TTR, N = 413; low TTR, N = 654) in the analysis. In unadjusted analysis, patients with a high TTR were older and less likely to have had strokes or receive other antiplatelet agents. Those patients also had lower NYHA class, better MLWHF scores, greater 6-minute walk distance, and lower frequency of HF hospitalizations. Multivariable analysis showed that NYHA class III and/or IV (Odds ratio [OR] 0.68 [95% confidence intervals [CIs] 0.49 to 0.94]), each 10-point increase in MLWHF score (i.e., worse health-related quality of life) (OR 0.92 [0.86 to 0.99]), and higher number of HF hospitalization per year (OR0.45 [0.30 to 0.67]) were associated with decreased likelihood of having high TTR. In HF patients with systolic dysfunction, NYHA class III and/or IV, poor health-related quality of life, and a higher rate of HF hospitalization were independently associated with suboptimal quality of warfarin anticoagulation control. These results affirm the need to assess the new approaches, such as direct oral anticoagulants, to prevent thromboembolism in this patient population.

Dataset Information

Cognitive Decline Over Time in Patients With Systolic Heart Failure: Insights From WARCEF.

Publications

Cognitive Decline Over Time in Patients With Systolic Heart Failure: Insights From WARCEF.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets