NEW ORLEANS—Elderly patients with heart failure have a significantly increased prevalence of dementia and mild cognitive impairment (MCI), compared with people of similar age without heart failure, according to an analysis of data collected from more than 6,000 US residents enrolled in a long-term observational study.
Patients diagnosed with either heart failure with reduced ejection fraction or heart failure with preserved ejection fraction had an 89% increased prevalence of dementia and a 41% increased prevalence of MCI, compared with people from the same cohort who did not develop heart failure. Investigators adjusted their analysis for several demographic and clinical variables, said Lucy S. Witt, MD, a researcher at the University of North Carolina in Chapel Hill, at the American Heart Association Scientific Sessions 2016. She speculated that the link between heart failure and dementia and MCI might result from impaired cerebral perfusion in patients with heart failure or from effects from heart failure medications.
Lucy S. Witt, MD
“Our findings suggest that clinicians should have a higher suspicion for cognitive impairment in patients with heart failure, regardless of other, more classic risk factors,” she said. “This knowledge could prompt physicians to perform testing [for dementia and MCI], initiate conversations regarding the goals of care or advance care planning, and discuss appropriate living situations” for their patients with heart failure.
The analysis used data collected for the Atherosclerosis Risk in Communities (ARIC) study, which began in 1987 and enrolled a randomly selected representative cohort of approximately 16,000 women and men between ages 45 and 64 who resided in any of four US communities. Dr. Witt specifically focused on the data collected from 6,431 of the participants who returned for a fifth follow-up examination between 2011 and 2013, including 5,490 people without heart failure, whose average age was 76, and 941 participants with heart failure, whose average age was 78.
The adjusted rate of dementia prevalence at the fifth follow-up visit was 5.6% among those without heart failure and 7.0% in those with heart failure. The examinations also found MCI in an adjusted 21.5% of those without heart failure and in 26.2% of those with heart failure, said Dr. Witt. Adjustments were for factors such as age, sex, location, education, hypertension, diabetes, depression, alcohol and tobacco use, cerebrovascular disease, and marital status.
The relative risk for dementia among patients with heart failure was roughly similar, regardless of whether ARIC participants had a reduced or preserved left ventricular ejection fraction, she said.
ARIC is funded by the National Heart, Lung, and Blood Institute. Dr. Witt had no disclosures.
—Mitchel L. Zoler
Suggested Reading
Adelborg K, Horváth-Puhó E, Ording A, et al. Heart failure and risk of dementia: a Danish nationwide population-based cohort study. Eur J Heart Fail. 2016 Sep 9 [Epub ahead of print].
Ampadu J, Morley JE. Heart failure and cognitive dysfunction. Int J Cardiol. 2015;178:12-23.
Rusanen M, Kivipelto M, Levälahti E, et al. Heart diseases and long-term risk of dementia and Alzheimer’s disease: a population-based CAIDE study. J Alzheimers Dis. 2014;42(1):183-191.