McLennan Skye N, Pearson Sue A, Cameron Janette, Stewart Simon
University of South Australia, Division of Health Science, Australia.
Eur J Heart Fail. 2006 Aug;8(5):494-501. doi: 10.1016/j.ejheart.2005.11.013. Epub 2006 Feb 28.
Cognitive impairment is common among chronic heart failure (CHF) patients.
To determine the prognostic significance of cognitive impairment in patients participating in a randomized study of a CHF management program (CHF-MP).
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.
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).
These data suggest that "mild" cognitive impairment is of prognostic importance in CHF: even when a CHF-MP has been applied.
认知障碍在慢性心力衰竭（CHF）患者中很常见。
确定参与CHF管理项目（CHF-MP）随机研究的患者中认知障碍的预后意义。
将CHF患者随机分为CHF-MP组（n = 100）或常规治疗组（n = 100）。使用简易精神状态检查表（MMSE）评估基线认知。根据是否存在认知障碍（MMSE 19 - 26）或无认知障碍（MMSE>26）比较五年全因死亡率以及死亡或再入院的合并情况。
27例患者（13.5%）存在认知障碍，经校正后，这些患者更有可能死亡（96.3%对68.2%，RR 2.19，95%CI 1.41至3.39：P<0.001）和/或经历非计划住院（100%对94%，RR 1.44，95%CI 1.06至1.95：P = 0.019）。认知障碍患者在CHF-MP组（RR 1.40，95%CI 0.63至3.11：P = 0.403）和常规治疗组（RR 1.38，95%CI 0.75至2.53：P = 0.305）中死亡或再入院的校正风险相似（无统计学意义）。在常规治疗队列中，认知障碍与更高的（无统计学意义）校正死亡风险相关（RR 1.61，95%CI 1.10至4.92：P = 0.122）。在CHF-MP组中，认知障碍患者的校正死亡风险显著更高（RR 2.33，95%CI 1.10至4.92：P = 0.027）。
这些数据表明，即使应用了CHF-MP，“轻度”认知障碍在CHF中仍具有预后重要性。
