Journal Article

Cognitive Function in Ambulatory Patients with Systolic Heart Failure: Insights from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) Trial

Di Tullio, Marco R., Teerlink, John R., Mann, Douglas L., Thompson, John L. P., Labovitz, Arthur J., Homma, Shunichi, Sacco, Ralph L., Lok, Dirk J., Estol, Conrado J., Sanford, Alexandra R., Ponikowski, Piotr, Anker, Stefan D., Mohr, J. P., Ye, Siqin, Qian, Min, Freudenberger, Ronald S., Graham, Susan, Levin, Bruce, Lip, Gregory Y. H., Pullicino, Patrick M.

2014

Overview

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.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Age Factors / Aged / Anticoagulants / Aspirin / Aspirin - therapeutic use / Biology and Life Sciences / Body mass / Body Mass Index / Body size / Cardiac patients / Cardiology / Clinical trials / Cognition / Cognitive ability / Cognitive impairment / Cross-Sectional Studies / Demographics / Diabetes / Educational Status / Exercise Tolerance / Failure analysis / Female / Fibrinolytic Agents - therapeutic use / Heart / Heart diseases / Heart failure / Heart Failure, Systolic - diagnosis / Heart Failure, Systolic - drug therapy / Heart Failure, Systolic - physiopathology / Hemoglobin / Hemoglobins / Hospitals / Humans / Male / Medicine / Medicine and Health Sciences / Middle Aged / Multivariate Analysis / Older people / Outpatients / Patients / Physical fitness / Public health / Regression analysis / Retrospective Studies / Severity of Illness Index / Smoking / Smoking - physiopathology / Stroke / Stroke Volume / Ventricle / Ventricular Function, Left / Walking / Warfarin / Warfarin - therapeutic use