Division of General Internal Medicine Weill Cornell Medicine New York NY USA.
Division of Cardiology Weill Cornell Medicine New York NY USA.
J Am Heart Assoc. 2024 Sep 3;13(17):e032986. doi: 10.1161/JAHA.123.032986. Epub 2024 Aug 29.
Cognitive impairment is common among adults with heart failure (HF) and associated with poor outcomes. However, less is known about the trajectory of cognitive decline after a first HF hospitalization. We examined the rate of cognitive decline among adults with incident HF hospitalization compared with those without HF hospitalization.
The REGARDS (Reasons for Geographic and Racial Differences in Stroke) study is a prospective longitudinal study of 23 894 participants aged ≥45 years free of HF at baseline. HF hospitalization was expert adjudicated. Changes in global cognitive function (primary outcome) were assessed with the Six-Item Screener (range, 0-6). Secondary outcomes included change in Word List Learning (range, 0-30), Word List Delayed Recall (WLD; range, 0-10), and Animal Fluency Test (range, 0+). Segmented linear mixed-effects regression models were used. Over 5 years, mean scores across all 4 cognitive tests declined for all participants regardless of HF status. Those with incident HF hospitalization experienced faster declines in the Six-Item Screener versus those who were HF free (difference, -0.031 [95% CI, -0.047 to -0.016]; <0.001), a finding that persisted in fully adjusted models. Those with incident HF hospitalization did not experience faster declines in Word List Learning, Word List Delayed Recall, or Animal Fluency Test scores compared with those without HF hospitalization. Participants with hospitalization for HF with preserved, compared with reduced, ejection fraction had faster decline in Animal Fluency Test.
Global cognitive decline occurred faster among adults with incident HF hospitalization compared with those who remained free of HF hospitalization. This pattern was not seen for the other cognitive domains.
认知障碍在心力衰竭（HF）患者中很常见，且与预后不良相关。然而，HF 首次住院后认知能力下降的轨迹知之甚少。我们研究了与无 HF 住院史的患者相比，HF 首次住院患者的认知能力下降率。
REGARDS（地理和种族差异中风原因）研究是一项对 23894 名年龄≥45 岁且基线时无 HF 的成年人进行的前瞻性纵向研究。HF 住院由专家裁定。采用六项目筛查器（范围 0-6）评估整体认知功能变化（主要结局）。次要结局包括单词列表学习变化（范围 0-30）、单词列表延迟回忆（WLD；范围 0-10）和动物流畅性测验（范围 0+）。采用分段线性混合效应回归模型。在 5 年内，所有认知测试的平均分数都有所下降，无论 HF 状态如何。与 HF 无住院史的患者相比，HF 首次住院患者的六项目筛查器得分下降更快（差异，-0.031[95%CI，-0.047 至-0.016]；<0.001），这一发现在完全调整后的模型中仍然存在。与无 HF 住院史的患者相比，HF 首次住院患者的单词列表学习、单词列表延迟回忆或动物流畅性测验得分没有更快下降。与射血分数降低的 HF 住院患者相比，射血分数保留的 HF 住院患者的动物流畅性测验下降更快。
与 HF 无住院史的患者相比，HF 首次住院患者的整体认知能力下降更快。这种模式在其他认知领域并未出现。
