认知障碍可预测门诊心力衰竭退伍军人的死亡率。
Cognitive impairment predicts mortality in outpatient veterans with heart failure.
作者信息
Lan Howard, Hawkins Lee Ann, Kashner Michael, Perez Elena, Firek Christopher J, Silvet Helme
机构信息
Loma Linda University Medical Center, 11234 Anderson St, Loma Linda, CA 92354, USA; VA Loma Linda Healthcare System, 11201 Benton St, Loma Linda, CA 92357, USA.
Indiana Wesleyan University, 4201 S Washington St, Marion, IN 46953, USA.
出版信息
Heart Lung. 2018 Nov;47(6):546-552. doi: 10.1016/j.hrtlng.2018.06.008. Epub 2018 Aug 22.
BACKGROUND
In our prior study of 250 outpatient veterans with heart failure (HF), 58% had unrecognized cognitive impairment (CI) which was linked to worsened medication adherence. Literature suggests HF patients with CI have poorer clinical outcomes including higher mortality.
OBJECTIVE
The study is to examine mortality rates in outpatients with HF and undiagnosed CI compared to their cognitively intact peers.
METHODS
This is a retrospective study for all-cause mortality.
RESULTS
During the 3-year follow up, 64/250 (25.6%) patients died: 20/106 (18.9%) with no CI, 29/104 (27.9%) with mild CI, and 15/40 (37.5%) with severe CI. Patients with CI were at increased risk for mortality (hazard ratio 1.82, p = 0.038). Those with severe CI had the worst outcome (hazard ratio 2.710, p = 0.011).
CONCLUSIONS
CI was an independent risk factor for mortality in patients with heart failure when controlling for age and markers of disease severity. Cognitive screening should be performed routinely to identify patients at greater risk for adverse outcomes.
背景
在我们之前对250名门诊心力衰竭（HF）退伍军人的研究中，58%的患者存在未被识别的认知障碍（CI），这与药物依从性变差有关。文献表明，患有CI的HF患者临床结局较差，包括死亡率更高。
目的
本研究旨在比较患有HF且未诊断出CI的门诊患者与其认知功能正常的同龄人之间的死亡率。
方法
这是一项关于全因死亡率的回顾性研究。
结果
在3年的随访期间，64/250（25.6%）名患者死亡：无CI的患者中20/106（18.9%）死亡，轻度CI的患者中29/104（27.9%）死亡，重度CI的患者中15/40（37.5%）死亡。患有CI的患者死亡风险增加（风险比1.82，p = 0.038）。重度CI患者的结局最差（风险比2.710，p = 0.011）。
结论
在控制年龄和疾病严重程度标志物时，CI是心力衰竭患者死亡的独立危险因素。应常规进行认知筛查，以识别不良结局风险更高的患者。
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