Elsevier

Journal of Cardiac Failure

Volume 16, Issue 9, September 2010, Pages 750-760
Journal of Cardiac Failure

Clinical Investigation
Memory Dysfunction, Psychomotor Slowing, and Decreased Executive Function Predict Mortality in Patients With Heart Failure and Low Ejection Fraction

https://doi.org/10.1016/j.cardfail.2010.04.007Get rights and content

Abstract

Background

The purpose of this study was to evaluate whether dysfunction of specific cognitive abilities is a predictor of impending mortality in adults with systolic heart failure (HF).

Methods

A total of 166 stable outpatients with HF completed cognitive function evaluation in language, working memory, memory, visuospatial ability, psychomotor speed, and executive function using a neuropsychological test battery. Demographic and clinical variables, comorbidity, depressive symptoms, and health-related quality of life were also measured. Patients were followed for 12 months to determine all-cause mortality.

Results

There were 145 survivors and 21 deaths. In logistic regression analyses, significant predictors of mortality were lower left ventricular ejection fraction (LVEF) and poorer scores on measures of global congnitive function Mini-Mental State Examination [MMSE], working memory, memory, psychomotor speed, and executive function. Memory loss was the most predictive cognitive function variable (overall χ2 = 17.97, df = 2, P < .001; Nagelkerke R2 = 0.20). Gender was a significant covariate in 2 models, with men more likely to die. Age, comorbidity, depressive symptoms, and health-related quality of life were not significant predictors. In further analyses, significant predictors of mortality were lower systolic blood pressure and poorer global cognitive function, working memory, memory, psychomotor speed, and executive function, with memory being the most predictive.

Conclusions

As hypothesized, lower LVEF and memory dysfunction predicted mortality. Poorer global cognitive score as determined by the MMSE, working memory, psychomotor speed, and executive function were also significant predictors. LVEF or systolic blood pressure had similar predictive values. Interventions are urgently needed to prevent and manage memory loss in HF.

Section snippets

Procedures

A prospective study design was used. The data were collected as part of a larger study conducted to evaluate cognitive dysfunction among 414 participants (249 HF patients, 63 healthy participants, and 102 medical participants).23 Data were collected from September 2004 through April 2009. The HF patients were enrolled from 5 outpatient clinic sites in the Midwest. Eligible patients were invited to participate in the study by clinic staff members. The names and contact information of interested

Results

Table 1 presents the demographic and baseline variables for the total sample of 166 patients and of the patients who were alive and those who died over the 12 months. Twelve months after the baseline interviews, 145 patients (87%) were living and 21 patients (13%) had died. A higher percentage of men died compared with women over the 12 months (P = .056). No significant differences were found in age, race, ethnicity, marital status, education, and premorbid intellect between the patients who

Discussion

To our knowledge, this is the first study to report that dysfunction in specific cognitive abilities of working memory, memory (verbal learning and visuospatial recall), psychomotor speed, and executive function are predictors of 12-month all-cause mortality in a general sample of outpatients with chronic HF. More severe HF as indicated by lower LVEF and worse scores on the MMSE, the Digit Span backward, the Hopkins Verbal Learning Test (delayed recall), the Figure Memory recall, the Digit

Acknowledgments

Co-investigators for the study “Cognitive Deficits in Chronic Heart Failure:” David Kareken, PhD, Mary Jane Sauvé, DNSc, Rebecca Sloan, PhD, and Usha Subramanian, MD. Assistance with data collection: Joan Barr, MSN, Clarian Health Partners, Indianapolis, IN; Kari Berron, MSN and Mary Walsh, MD, The Care Group, Indianapolis, IN; Cynthia Adams, PhD, Sara Fickle, MSN, Cynthia Kennedy, MSN, Jeanne Majors, MSN, Sharon Sipos, AD, and Linda Trowbridge, RN, Community Health Network of Indianapolis;

Disclosures

This work was supported by the National Institute of Nursing Research. The authors have no other disclosures related to this study.

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    Funded by the National Institute of Nursing Research R01NR008147. Supported by the National Institute of Nursing Research. Institutions where work was done: Indiana University, Indianapolis, Indiana and University of Michigan, Ann Arbor, Michigan.

    See page 758 for disclosure information.

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