Memory dysfunction, psychomotor slowing, and decreased executive function predict mortality in patients with heart failure and low ejection fraction.
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 chi(2) = 17.97, df = 2, P < .001; Nagelkerke R(2) = 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.
Pressler
Susan J
SJ
University of Michigan School of Nursing, Ann Arbor, MI 48109, USA. spressle@umich.edu
Kim
Jinshil
J
Riley
Penny
P
Ronis
David L
DL
Gradus-Pizlo
Irmina
I
D000368:Aged; D016001:Confidence Intervals; D056344:Executive Function; D005080:Exercise Test; D005260:Female; D006305:Health Status Indicators; D006333:Heart Failure / Q000150:complications* / Q000401:mortality / Q000523:psychology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008568:Memory; D008569:Memory Disorders / Q000209:etiology*; D009048:Motor Skills; D009483:Neuropsychological Tests; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D011594:Psychometrics; D011788:Quality of Life; D012306:Risk; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D011795:Surveys and Questionnaires; D014481:United States; D016277:Ventricular Function, Left
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