TY - JOUR
T1 - Risk evaluation of cognitive impairment in patients with heart failure
T2 - A call for action
AU - Kuipers, Sanne
AU - Greving, Jacoba P
AU - Brunner-La Rocca, Hans-Peter
AU - Gottesman, Rebecca F
AU - van Oostenbrugge, Robert J
AU - Williams, Nicole L
AU - Jan Biessels, Geert
AU - Jaap Kappelle, L
AU - Heart-Brain Connection Consortium
N1 - Funding Information:
The TIME-CHF study was supported by the Helmut Horten Foundation (Lugano, Switzerland), and by smaller unrestricted grants from Roche Diagnostics, AstraZeneca, Novartis, Menarini, Pfizer, Servier, Roche Pharma, and Merck. The ECHO-study was supported by a NIH/ National Institute on Aging award K24 AG052573 and the McKhann Scholar award. This work is part of the Heart-Brain Connection crossroads (HBCx) consortium of the Dutch CardioVascular Alliance (DCVA). HBCx has received funding from the Dutch Heart Foundation under grant agreement 2018-28.
Publisher Copyright:
© 2022 The Authors
PY - 2022/12
Y1 - 2022/12
N2 - Background: Cognitive impairment (CI) is common in patients with heart failure (HF) and impacts treatment adherence and other aspects of patient life in HF. Recognition of CI in patients with HF is therefore important. We aimed to develop a risk model with easily available patient characteristics, to identify patients with HF who are at high risk to be cognitively impaired and in need for further cognitive investigation.Methods & results: The risk model was developed in 611 patients ≥ 60 years with HF from the TIME-CHF trial. Fifty-six (9 %) patients had CI (defined as Hodkinson Abbreviated Mental Test ≤ 7). We assessed the association between potential predictors and CI with least-absolute-shrinkage-and-selection-operator (LASSO) regression analysis. The selected predictors were: older age, female sex, NYHA class III or IV, Charlson comorbidity index ≥ 6, anemia, heart rate ≥ 70 bpm and systolic blood pressure ≥ 145 mmHg. A model that combined these variables had a c-statistic of 0.70 (0.63-0.78). The model was validated in 155 patients ≥ 60 years with HF from the ECHO study. In the validation cohort 51 (33 %) patients had CI (defined as a Mini Mental State Exam ≤ 24). External validation showed an AUC of 0.56 (0.46-0.66).Conclusions: This risk model with easily available patient characteristics has poor predictive performance in external validation, which may be due to case-mix variation. These findings underscore the need for active screening and standardized assessment for CI in patients with HF.
AB - Background: Cognitive impairment (CI) is common in patients with heart failure (HF) and impacts treatment adherence and other aspects of patient life in HF. Recognition of CI in patients with HF is therefore important. We aimed to develop a risk model with easily available patient characteristics, to identify patients with HF who are at high risk to be cognitively impaired and in need for further cognitive investigation.Methods & results: The risk model was developed in 611 patients ≥ 60 years with HF from the TIME-CHF trial. Fifty-six (9 %) patients had CI (defined as Hodkinson Abbreviated Mental Test ≤ 7). We assessed the association between potential predictors and CI with least-absolute-shrinkage-and-selection-operator (LASSO) regression analysis. The selected predictors were: older age, female sex, NYHA class III or IV, Charlson comorbidity index ≥ 6, anemia, heart rate ≥ 70 bpm and systolic blood pressure ≥ 145 mmHg. A model that combined these variables had a c-statistic of 0.70 (0.63-0.78). The model was validated in 155 patients ≥ 60 years with HF from the ECHO study. In the validation cohort 51 (33 %) patients had CI (defined as a Mini Mental State Exam ≤ 24). External validation showed an AUC of 0.56 (0.46-0.66).Conclusions: This risk model with easily available patient characteristics has poor predictive performance in external validation, which may be due to case-mix variation. These findings underscore the need for active screening and standardized assessment for CI in patients with HF.
U2 - 10.1016/j.ijcha.2022.101133
DO - 10.1016/j.ijcha.2022.101133
M3 - Article
C2 - 36246772
SN - 2352-9067
VL - 43
JO - IJC Heart and Vasculature
JF - IJC Heart and Vasculature
M1 - 101133
ER -