title: Cognitive function in ambulatory patients with systolic heart failure: insights from the warfarin versus aspirin in reduced cardiac ejection fraction (WARCEF) trial.
abstract: We sought to determine whether cognitive function in stable outpatients with heart failure (HF) is affected by HF severity. A retrospective, cross-sectional analysis was performed using data from 2, 043 outpatients with systolic HF and without prior stroke enrolled in the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) Trial. Multivariable regression analysis was used to assess the relationship between cognitive function measured using the Mini-Mental Status Exam (MMSE) and markers of HF severity (left ventricular ejection fraction [LVEF], New York Heart Association [NYHA] functional class, and 6-minute walk distance). The mean (SD) for the MMSE was 28.6 (2.0), with 64 (3.1%) of the 2,043 patients meeting the cut-off of MMSE <24 that indicates need for further evaluation of cognitive impairment. After adjustment for demographic and clinical covariates, 6-minute walk distance (β-coefficient 0.002, p<0.0001), but not LVEF or NYHA functional class, was independently associated with the MMSE as a continuous measure. Age, education, smoking status, body mass index, and hemoglobin level were also independently associated with the MMSE. In conclusion, six-minute walk distance, but not LVEF or NYHA functional class, was an important predictor of cognitive function in ambulatory patients with systolic heart failure.
authors.affiliation: Division of Cardiology, Department of Medicine, State University of New York Upstate Medical University, Buffalo, New York, United States of America.
authors.forename: Susan
authors.initials: S
authors.lastname: Graham
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America.
authors.forename: Siqin
authors.initials: S
authors.lastname: Ye
authors.affiliation: Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, United States of America.
authors.forename: Min
authors.initials: M
authors.lastname: Qian
authors.affiliation: Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, United States of America.
authors.forename: Alexandra R
authors.initials: AR
authors.lastname: Sanford
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America.
authors.forename: Marco R
authors.initials: MR
authors.lastname: Di Tullio
authors.affiliation: Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States of America.
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.affiliation: Department of Medicine, Washington University, St. Louis, Missouri, United States of America.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Mann
authors.affiliation: Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, United States of America.
authors.forename: Bruce
authors.initials: B
authors.lastname: Levin
authors.affiliation: Kent Institute of Medicine and Health Sciences, University of Kent, Canterbury, United Kingdom.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Pullicino
authors.affiliation: Division of Cardiology, Department of Medicine, Lehigh Valley Hospital, Allentown, Pennsylvania, United States of America.
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Freudenberger
authors.affiliation: Section of Cardiology, Department of Medicine, San Francisco Veterans Affairs Medical Center, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: John R
authors.initials: JR
authors.lastname: Teerlink
authors.affiliation: Department of Neurology, Columbia University Medical Center, New York, New York, United States of America.
authors.forename: J P
authors.initials: JP
authors.lastname: Mohr
authors.affiliation: Department of Cardiovascular Medicine, University of South Florida, Tampa, Florida, United States of America.
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Labovitz
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.affiliation: Centro Neurológico de Tratamiento y Rehabilitación, Buenos Aires, Argentina.
authors.forename: Conrado J
authors.initials: CJ
authors.lastname: Estol
authors.affiliation: Department of Cardiology, Deventer Hospital, Deventer, Overijssel, The Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Lok
authors.affiliation: Department of Heart Diseases, Wroclaw Medical University, Military Hospital, Wroclaw, Lower Silesia, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
authors.affiliation: Department of Innovative Clinical Trials, University Medical Centre Göttingen, Göttingen, Lower Saxony, Germany.
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.affiliation: Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, United States of America.
authors.forename: John L P
authors.initials: JL
authors.lastname: Thompson
authors.affiliation: Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, United States of America.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
mesh_terms: D000367:Age Factors; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use*; D015992:Body Mass Index; D003071:Cognition; D003430:Cross-Sectional Studies; D004522:Educational Status; D017079:Exercise Tolerance; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D054143:Heart Failure, Systolic / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010045:Outpatients; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012907:Smoking / Q000503:physiopathology; D013318:Stroke Volume; D016277:Ventricular Function, Left; D016138:Walking; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D014859:Warfarin; D001241:Aspirin