Written by Peter Liu
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For patients with heart failure with preserved ejection fraction (HFpEF), even mild cognitive dysfunction predicts worse HF outcomes, such as hospitalization and death.
Cognitive dysfunction predicts worse outcomes in heart failure
Care for patients with heart failure runs the full gamut of the physician scope of care, from disease prevention and health optimization, to symptom prevention, to symptom control, and finally to end of life care. Individualizing care is important, which requires identifying prognostically important factors that influence the patient’s health. The featured study today investigated the association between cognitive dysfunction and clinical outcomes in HFpEF using data from the PARAGON-HF RCT (which studied angiotensin receptor-neprilysin inhibitor vs ARB in HFpEF). In this study, baseline cognitive function was measured via the Mini-Mental State Examination (MMSE), and subsequent changes were tracked. Lower baseline MMSE scores (<24) were significantly associated with increased risks of heart failure hospitalization and cardiovascular mortality (adjusted HR 1.58, 95%CI 1.21–2.06). Cognitive decline over 48 weeks (e.g. a drop in MMSE of 3 or more) predicted higher mortality risks. Even mild differences in baseline MMSE (such as an MMSI score of 24-27) predicted a higher risk of cardiovascular death or hospitalization (aHR 1.27, 1.06-1.53).
How does this change my practice?
These findings suggest that even mild cognitive impairment is a significant independent predictor of adverse HFpEF outcomes. If patients present with evidence of cognitive impairment in addition to other worrisome prognostic factors, it would prompt me to consider intensified monitoring and follow-up, and to begin addressing anticipatory guidance, potentially introducing palliative care to the care plan sooner rather than later. The only question that remains is whether or not cognitive impairment can be reversed, and if it is, does it change mortality?
Source
Clinical Correlates and Prognostic Impact of Cognitive Dysfunction in Patients With Heart Failure and Preserved Ejection Fraction: Insights From PARAGON-HF. Circulation. 2024 Dec 10;150(24):1913-1927. doi: 10.1161/CIRCULATIONAHA.124.070553. Epub 2024 Oct 21. PMID: 39429145
