title: Prognostic importance of cognitive impairment in chronic heart failure patients: does specialist management make a difference?
abstract: BACKGROUND
  Cognitive impairment is common among chronic heart failure (CHF) patients.
  
  
  OBJECTIVE
  To determine the prognostic significance of cognitive impairment in patients participating in a randomized study of a CHF management program (CHF-MP).
  
  
  METHODS
  CHF patients were randomized to a CHF-MP (n=100) or usual care (n=100). Baseline cognition was assessed using the Mini Mental Status Examination (MMSE). Five-year all-cause mortality, and combined death-or-readmission, were compared on the basis of the presence (MMSE 19-26) or absence (MMSE >26) of cognitive impairment.
  
  
  RESULTS
  27 patients (13.5%) had cognitive impairment and, on an adjusted basis, were more likely to die (96.3% versus 68.2%. RR 2.19, 95% CI 1.41 to 3.39: P<0.001) and/or experience an unplanned hospitalization (100% versus 94%. RR 1.44, 95% CI 1.06 to 1.95: P=0.019). Cognitively impaired patients had a similar (non-significant) adjusted risk of death-or-readmission in both the CHF-MP (RR 1.40, 95% CI 0.63 to 3.11: P=0.403) and in usual care (RR 1.38, 95% CI 0.75 to 2.53: P=0.305). In the usual care cohort, cognitive impairment was associated with a greater (non-significant), adjusted risk of death (RR 1.61, 95% CI 1.10 to 4.92: P=0.122). In the CHF-MP, adjusted risk of death was significantly higher for cognitively impaired patients (RR 2.33, 95% CI 1.10 to 4.92: P=0.027).
  
  
  CONCLUSIONS
  These data suggest that "mild" cognitive impairment is of prognostic importance in CHF: even when a CHF-MP has been applied.
authors.affiliation: University of South Australia, Division of Health Science, Australia.
authors.forename: Skye N
authors.initials: SN
authors.lastname: McLennan
authors.forename: Sue A
authors.initials: SA
authors.lastname: Pearson
authors.forename: Janette
authors.initials: J
authors.lastname: Cameron
authors.forename: Simon
authors.initials: S
authors.lastname: Stewart
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000401:mortality*; D006801:Humans; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016019:Survival Analysis