Abstract 12237: Blunted Responses to Heart Failure Symptoms in Adults with Mild Cognitive Dysfunction
Introduction: The clinical impact of mild cognitive dysfunction in heart failure (HF) is unknown. We hypothesized that mild cognitive dysfunction would be associated with poor HF self-care behaviors.
Methods: We analyzed data on 102 participants in an observational study of symptoms in adults with advanced HF. Mild cognitive dysfunction was measured with the Montreal Cognitive Assessment (MoCA, range 0-30), using scores < 26 (established standard cutoff) and < 24 (established cutoff for adults with cardiovascular disease). HF self-care maintenance (routine adherence behaviors) and management (evaluation and response to HF symptoms when they occur) were measured with the Self-Care of HF Index (SCHFI); scores range from 0-100 with higher values indicating better self-care. Generalized linear modeling was used to quantify the relationship between MoCA cutoff scores and SCHFI maintenance and management scores.
Results: The average age of the sample was 57±12 years, 65% were male, 39% had NYHA class II HF and 61% had class III/IV HF; the average LVEF was 27±9%. 32% and 13% of the sample had mild cognitive dysfunction using MoCA scores of 26 and 24, respectively. Average SCHFI maintenance scores were 69±15 and SCHFI management scores were 66±18. Controlling for age, gender, NYHA class, and LVEF, participants with MoCA scores < 26 reported self-care behaviors comparable to participants with MoCA scores ≥ 26. Controlling for age, gender, NYHA class, and LVEF, participants with MoCA scores < 24 had similar SCHFI maintenance, but worse SCHFI management scores (38.4%±21.5% lower, P=0.016) compared with participants with MoCA scores ≥ 24.
Conclusions: When the standard cutoff was used to detect mild cognitive dysfunction in adults with advanced HF, no clinically-meaningful differences in HF self-care were observed. In contrast, the cutoff for mild cognitive dysfunction specific to chronic cardiovascular disease revealed marked impairment in patients' ability to recognize and respond to HF symptoms when they occur. These results suggest that alternative strategies for symptom monitoring and management should be implemented in adults with mild cognitive dysfunction.
- © 2011 by American Heart Association, Inc.