[Correlation between evolution of the cognitive function and mortality after hospital discharge in elderly patients with advanced heart failure].
OBJECTIVE
To assess the relation between the evolution of cognitive performance and the prognosis of elderly patients after compensation of advanced heart failure.


METHODS
Thirty-one patients older than 64 (68 +/- 7) years and admitted with New York Heart Association class IV heart failure and ejection fraction = 0.45 (0.38 +/- 0.06) were consecutively selected. They underwent cognitive tests (digit span, digit symbol, letter cancellation, trail making A and B) and the 6-minute walking test 4 days before (T1) and 6 weeks after (T2) hospital discharge, and their performances were compared using the t test. The prognostic value of the scores of the cognitive tests was analyzed with logistic regression, and the value of greatest accuracy of the tests was associated with the prognosis determined by the ROC curve.


RESULTS
After 24.7 months, 17 (55%) patients had died. The performances in the 6-minute walking test and most cognitive tests improved between T1 and T2. The digit span score of the survivors ranged from 3.9 to 5.2 (P=0.003) and remained unaltered among those who died (4.1 to 3.9; P=0.496). An improvement < 0.75 points in the score was associated with mortality (relative risk of 8.1; P=0.011).


CONCLUSIONS
In the elderly, after compensation of advanced heart failure, the lack of evolutionary improvement in cognitive performance was associated with a worse prognosis.
Ochiai
Marcelo E
ME
Instituto do Coração, Hospital das Clínicas, FM, USP. mochiai@osite.com.br
Franco
Luciano L S
LL
Gebara
Otávio C E
OC
Nussbacher
Amit
A
Serro-Azul
João B
JB
Pierri
Humberto
H
Rays
Jairo
J
Barretto
Antonio C P
AC
Wajngarten
Mauricio
M
D000368:Aged; D001938:Brazil / Q000453:epidemiology; D003071:Cognition / Q000502:physiology*; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011379:Prognosis; D016019:Survival Analysis; D015996:Survival Rate; D016138:Walking / Q000502:physiology