Abstract 12474: Adults with Heart Failure Have Worsening Cognitive Deficits as Comorbidity Increases

Abstract

Up to 50% of heart failure (HF) patients have cognitive impairment. The contribution of comorbid conditions to impaired cognition is unclear. The purpose of this study was to determine if there are differences in cognition based on comorbidity severity among adults with HF.

Methods: Adults with a confirmed diagnosis of symptomatic chronic HF were enrolled from 3 sites in the northeastern US after excluding individuals with dementia, recent drug or alcohol abuse, and major depression. Baseline data obtained from 280 subjects were used to test the hypothesis that the domains of cognition (attention, memory, executive function, and processing speed), measured using a battery of neuropsychological tests, differ based on comorbidity severity. MANOVA was used to test for differences in the time needed to complete each test among patients with low, moderate, and high levels of comorbidity measured with the Charlson Comorbidity Index after adjusting for age and NYHA functional class.

Results: Complete data were available on 268 HF patients (64.2% male, 62±12 years old, 58.2% NYHA class III). After correcting for age and NYHA class, only the Digit Symbol Substitution Task (DSST) (processing speed), Trail Making tests (TMT) A and B (complex attention) differed significantly among the three comorbidity groups (Table). Differences were in the expected direction (DSST, higher is better; TMT, lower is better). Age was significantly associated with working memory (probed memory recall) and short-term memory (letter number sequencing). Both age and NYHA were significantly associated with simple attention.

Conclusions: High levels of comorbid illness are associated with worse processing speed and complex attention even after controlling for age and HF severity. In patients with more comorbid conditions, accounting for presumed deficits in processing speed and complex attention may improve clinical interactions.