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Int J Environ Res Public Health. 2018 Dec 27;16(1). pii: E66. doi: 10.3390/ijerph16010066.

Combined Influence of Depression and Physical Frailty on Cognitive Impairment in Patients with Heart Failure.

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College of Nursing, Dankook University, Cheonan 31116, Korea.
Department of Nursing, Wonkwang University, Iksan 54538, Korea.
Red Cross College of Nursing, Chung-Ang University, Seoul 06974, Korea.


Cognitive impairment is a prevalent condition and important barrier to self-care behaviors in patients with heart failure (HF). HF patients with depression or physical frailty are more likely to have reduced cognitive function. However, it remains unclear if combined depression and physical frailty increased the risk of cognitive impairments among HF populations. This study aimed to identify the influence of combined depression and physical frailty on cognitive impairments in HF. This cross-sectional study was included 289 patients with HF in outpatient cardiology clinics at a tertiary care university hospital in Cheonan, South Korea. We obtained patients' characteristics including depression, physical frailty, and cognitive function with Korean validated tools using a face-to-face interview. The prevalence rate of cognitive impairment was approximately 27.3% in HF outpatients. We found that the combined influence of depression and physical frailty increased the risk of cognitive impairments in both unadjusted (odds ratio (OR) 4.360; 95% confidence interval (CI) (2.113, 8.994)) and adjusted models (OR 3.545; 95% CI (1.448, 8.681)). Our findings highlight that healthcare professionals need to be more aware of the vulnerable population who suffer from both depression and physical frailty at the same time. Future prospective studies should examine the causal relationships among depression, physical frailty and cognitive impairment during the HF illness trajectories.


cognitive impairments; depression; frailty; heart failure; outpatients

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