Prognostic importance of cognitive impairment in chronic heart failure patients: Does specialist management make a difference?

Background: Cognitive impairment is common among chronic heart failure (CHF) patients. Aims: To determine the prognostic significance of cognitive impairment in patients participating in a randomized study of a CHF management program (CHF-MP). Methods: CHF patients were randomized to a CHF-MP (n = 100) or usual care (n = 100). Baseline cognition was assessed using the Mini Mental Status Examination (MMSE). Five-year all-cause mortality, and combined death-or-readmission, were compared on the basis of the presence (MMSE 19-26) or absence (MMSE > 26) of cognitive impairment. Results: 27 patients (13.5%) had cognitive impairment and, on an adjusted basis, were more likely to die (96.3% versus 68.2%. RR 2.19, 95% CI 1.41 to 3.39: P < 0.001) and/or experience an unplanned hospitalization (100% versus 94%. RR 1.44, 95% CI 1.06 to 1.95: P = 0.019). Cognitively impaired patients had a similar (non-significant) adjusted risk of death-or-readmission in both the CHF-MP (RR 1.40, 95% CI 0.63 to 3.11: P = 0.403) and in usual care (RR 1.38, 95% CI 0.75 to 2.53: P = 0.305). In the usual care cohort, cognitive impairment was associated with a greater (non-significant), adjusted risk of death (RR 1.61, 95% CI 1.10 to 4.92: P = 0.122). In the CHF-MP, adjusted risk of death was significantly higher for cognitively impaired patients (RR 2.33, 95% CI 1.10 to 4.92: P = 0.027). Conclusion: These data suggest that "mild" cognitive impairment is of prognostic importance in CHF: even when a CHF-MP has been applied.