title: Role of a multidisciplinary program in improving outcomes in cognitively impaired heart failure older patients.
abstract: BACKGROUND
  Cognitive impairment (CI) frequently complicates Heart failure (HF) and is associated with increased mortality and morbidity. Previous studies reported that nurse-lead home-based multidisciplinary program (MP) may not improve the prognosis of this high-risk group. In the present study, we analysed the relative effectiveness of an integrated hospital-based MP in patients with cognitive impairment.
  
  
  METHODS
  Consecutive (n = 173) community-living outpatients aged > 70 years (mean 77 +/- 6, 48% women) randomized to a MP (n = 86) or usual care (UC) (n = 87) were enrolled in stable clinical conditions. Cognitive status was assessed by means of Folstein Mini Mental State Examination (MMSE).
  
  
  RESULTS
  CI (MMSE < or = 24) was present in 41.6% (42,5% UC vs 40.7% MP p =ns). The variables independently associated to CI were: older age, education level <5 years, anemia and severe renal dysfunction. During a 2-year follow-up, 59 patients died (31.4%) with no significant difference between intervention group. At multivariate analysis, in the entire cohort, CI was independently associated to death (HR 2,07 7[95%CI 1,097-3,931]), HF admissions (2,133[1,346-3,381]), death/HF admissions (1,784[1,132-2,811]) and all-cause admissions (1,473[1,008-2,153]. When considered according to intervention groups, CI was independently associated to all-cause death (3,603 [1,553-8,358], death/HF admissions (2,029[1,200-3,432]) and HF admissions (2,474[1,406-4,353]) but not to all-cause admissions. The assignment of patients with CI to MP was associated to a significant reduction in HF admissions vs UC (0,503[0,253-0,999] (all interaction tests p = ns).
  
  
  CONCLUSIONS
  This study suggests that CI is very common and associated to worse prognosis in heart failure and that hospital-based MP seems to improve outcomes in these patients through reduction of heart failure hospital admission.
authors.affiliation: Heart Failure Unit, Division of Cardiology, INRCA Institute of Care and Research for Elderly, Rome, Italy. gipulig@yahoo.it
authors.forename: Donatella
authors.initials: D
authors.lastname: Del Sindaco
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pulignano
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
authors.forename: Luigi
authors.initials: L
authors.lastname: Tarantini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cioffi
authors.forename: Stefano
authors.initials: S
authors.lastname: Tolone
authors.forename: Maria Denitza
authors.initials: MD
authors.lastname: Tinti
authors.forename: Luca
authors.initials: L
authors.lastname: Monzo
authors.forename: Giulia
authors.initials: G
authors.lastname: Barbati
authors.forename: Giovanni
authors.initials: G
authors.lastname: Minardi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000150:complications / Q000628:therapy*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D010348:Patient Care Team