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Eur J Heart Fail. 2006 Aug;8(5):494-501. Epub 2006 Feb 28.

Prognostic importance of cognitive impairment in chronic heart failure patients: does specialist management make a difference?

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University of South Australia, Division of Health Science, Australia.



Cognitive impairment is common among chronic heart failure (CHF) patients.


To determine the prognostic significance of cognitive impairment in patients participating in a randomized study of a CHF management program (CHF-MP).


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.


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).


These data suggest that "mild" cognitive impairment is of prognostic importance in CHF: even when a CHF-MP has been applied.

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