Kewcharoen Jakrin, Prasitlumkum Narut, Kanitsoraphan Chanavuth, Charoenpoonsiri Nattawat, Angsubhakorn Natthapon, Putthapiban Prapaipan, Rattanawong Pattara
University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA.
Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Saudi Heart Assoc. 2019 Oct;31(4):170-178. doi: 10.1016/j.jsha.2019.06.001. Epub 2019 Jun 18.
Recent systematic review and meta-analysis showed that the prevalence of cognitive impairment was significantly increased in patients with heart failure (HF) when compared to the general population. However, the effect of cognitive impairment on cardiovascular outcome in this population is still unclear. We performed a systematic review and meta-analysis to assess whether cognitive impairment associated with worse outcome in patients with HF.
We comprehensively searched the databases of MEDLINE and EMBASE from inception to October 2018. Included studies were published cohort (prospective or retrospective) or randomized control trials that evaluate the effect of cognitive impairment mortality in HF patients. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate pooled hazard ratios (HR) and 95% confidence intervals (CI).
Eight studies were included in the analysis involving 3318 participants (951 participants had cognitive impairment). In a random-effects model, our analysis demonstrated that cognitive impairment significantly increased the risk of mortality in HF patients (pooled HR = 1.64, 95% CI = 1.42-1.88, I = 0.0%, < 0.001).
Our systematic review and meta-analysis showed that the presence of cognitive impairment is strongly associated with an increased mortality risk in the HF population. Further research is needed to explore the pathophysiology of this association.
近期的系统评价和荟萃分析表明，与普通人群相比，心力衰竭（HF）患者认知障碍的患病率显著增加。然而，认知障碍对该人群心血管结局的影响仍不明确。我们进行了一项系统评价和荟萃分析，以评估HF患者中认知障碍是否与更差的结局相关。
我们全面检索了MEDLINE和EMBASE数据库，检索时间从数据库创建至2018年10月。纳入的研究为发表的队列研究（前瞻性或回顾性）或随机对照试验，评估认知障碍对HF患者死亡率的影响。使用DerSimonian和Laird的随机效应、通用逆方差方法合并每项研究的数据，以计算合并风险比（HR）和95%置信区间（CI）。
八项研究纳入分析，涉及3318名参与者（951名参与者有认知障碍）。在随机效应模型中，我们的分析表明，认知障碍显著增加了HF患者的死亡风险（合并HR = 1.64，95%CI = 1.42 - 1.88，I² = 0.0%，P < 0.001）。
我们的系统评价和荟萃分析表明，认知障碍的存在与HF人群死亡风险增加密切相关。需要进一步研究来探索这种关联的病理生理学。
