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

WARCEF Investigators

Research output: Contribution to journalArticle

1 Citation (Scopus)

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)

Original languageEnglish (US)
Pages (from-to)1042-1053
Number of pages12
JournalJACC: Heart Failure
Volume7
Issue number12
DOIs
StatePublished - Dec 2019
Externally publishedYes

Fingerprint

Systolic Heart Failure
Warfarin
Aspirin
Odds Ratio
Confidence Intervals
Heart Failure
Cognition
Education
Needs Assessment
Cognitive Dysfunction
Hispanic Americans
Linear Models
Logistic Models
Demography
Mortality

Keywords

  • cognitive function
  • comorbidities
  • dementia
  • longitudinal analysis
  • Mini-Mental State Examination

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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

In: JACC: Heart Failure, Vol. 7, No. 12, 12.2019, p. 1042-1053.

Research output: Contribution to journalArticle

@article{7457372fc4204710bdaa7b63b5ab5f70,
title = "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)",
keywords = "cognitive function, comorbidities, dementia, longitudinal analysis, Mini-Mental State Examination",
author = "{WARCEF Investigators} and Lee, {Tetz C.} and Min Qian and Yutong Liu and Susan Graham and Mann, {Douglas L.} and Koki Nakanishi and Teerlink, {John R.} and Lip, {Gregory Y.H.} and Freudenberger, {Ronald S.} and Sacco, {Ralph L.} and Mohr, {Jay P.} and Labovitz, {Arthur J.} and Piotr Ponikowski and Lok, {Dirk J.} and Kenji Matsumoto and Conrado Estol and Anker, {Stefan D.} and Pullicino, {Patrick M.} and Richard Buchsbaum and Bruce Levin and Thompson, {John L.P.} and Shunichi Homma and {Di Tullio}, {Marco R.}",
year = "2019",
month = "12",
doi = "10.1016/j.jchf.2019.09.003",
language = "English (US)",
volume = "7",
pages = "1042--1053",
journal = "JACC: Heart Failure",
issn = "2213-1779",
publisher = "Elsevier BV",
number = "12",

}

TY - JOUR

T1 - Cognitive Decline Over Time in Patients With Systolic Heart Failure

T2 - Insights From WARCEF

AU - WARCEF Investigators

AU - Lee, Tetz C.

AU - Qian, Min

AU - Liu, Yutong

AU - Graham, Susan

AU - Mann, Douglas L.

AU - Nakanishi, Koki

AU - Teerlink, John R.

AU - Lip, Gregory Y.H.

AU - Freudenberger, Ronald S.

AU - Sacco, Ralph L.

AU - Mohr, Jay P.

AU - Labovitz, Arthur J.

AU - Ponikowski, Piotr

AU - Lok, Dirk J.

AU - Matsumoto, Kenji

AU - Estol, Conrado

AU - Anker, Stefan D.

AU - Pullicino, Patrick M.

AU - Buchsbaum, Richard

AU - Levin, Bruce

AU - Thompson, John L.P.

AU - Homma, Shunichi

AU - Di Tullio, Marco R.

PY - 2019/12

Y1 - 2019/12

N2 - 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)

AB - 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)

KW - cognitive function

KW - comorbidities

KW - dementia

KW - longitudinal analysis

KW - Mini-Mental State Examination

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U2 - 10.1016/j.jchf.2019.09.003

DO - 10.1016/j.jchf.2019.09.003

M3 - Article

C2 - 31779926

AN - SCOPUS:85074926628

VL - 7

SP - 1042

EP - 1053

JO - JACC: Heart Failure

JF - JACC: Heart Failure

SN - 2213-1779

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