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J Cardiovasc Nurs. 2016 Jan-Feb;31(1):62-8. doi: 10.1097/JCN.0000000000000216.

Evidence-Based Heart Failure Medications and Cognition.

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Lisa C. Bratzke, PhD, RN, ANP-BC Assistant Professor, School of Nursing, University of Wisconsin, Madison. Debra K. Moser, PhD, RN, FAAN Professor and Linda C. Gill Chair, College of Nursing, University of Kentucky, Lexington. Michele M. Pelter, PhD, RN Associate Professor, Orvis School of Nursing, University of Nevada, Reno. Steven M. Paul, PhD Principal Statistician, School of Nursing, University of California, San Francisco. Thomas S. Nesbitt, MD, MPH Associate Vice Chancellor for Strategic Technologies and Alliances, School of Medicine, University of California, Davis. Lawton S. Cooper, MD, MPH Medical Officer, Division of Cardiovascular Sciences, National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, Maryland. Kathleen A. Dracup, PhD, RN, FNP, FAAN Professor Emeritus, School of Nursing, University of California, San Francisco.



The etiology of cognitive impairment in heart failure (HF) is controversial and likely multifactorial. Physicians may hesitate to prescribe evidence-based HF medication because of concerns related to potential negative changes in cognition among a population that is already frequently impaired. We conducted a study to determine if prescription of evidence-based HF medications (specifically, β-blockers, angiotensin-converting enzyme inhibitors, angiotensin-receptor blocking agents, diuretics, and aldosterone inhibitors) was associated with cognition in a large HF sample.


A total of 612 patients completed baseline data collection for the Rural Education to Improve Outcomes in Heart Failure clinical trial, including information about medications. Global cognition was evaluated using the Mini-Cog.


The sample mean (SD) age was 66 (13) years, 58% were men, and 89% were white. Global cognitive impairment was identified in 206 (34%) of the 612 patients. Prescription of evidence-based HF medications was not related to global cognitive impairment in this sample. This relationship was maintained even after adjusting for potential confounders (eg, age, education, and comorbid burden).


Prescription of evidence-based HF medications is not related to low scores on a measure of global cognitive function in rural patients with HF.

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