Scripties UMCG - Rijksuniversiteit Groningen
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Prevalence of cognitive impairment and depression in patients with heart failure

(2017) Paques, V.A.

Introduction: Cognitive impairment (CI) and depression are common in patients with heart failure (HF), but the reported prevalences vary respectively from 25% to 75% and from 20% to 30%, while prevalences in the Netherlands are lacking. HF, CI and depression share several common pathological processes and risk factors, and cause or consequence has been a subject of discussion. Owing to an aging population the prevalence of HF, and therefore also the prevalence of CI an depression, are expected to increase in the future, however little attention is still paid to recognize these disorders. Timely recognition of CI and depression is important for providing optimal patient care. It may allow adjustment of medication and lifestyle regimes, simplification of dietary restrictions, and better coordination of appointments. This may prevent unnecessary hospital admissions and preserve quality of life. Therefore, the aim of our study was to determine the prevalence of CI and depression in an older population of people with HF. Secondly, we wanted to determine the extent to which these disorders are recognized by the treating physician.
Methods: We performed a descriptive, cross-sectional study of patients>65 diagnosed with HF. Patients were recruited from a public hospital, where they were approached for inclusion in the study at the outpatient clinic of Cardiology. Cognitive status was evaluated with the Montreal Cognitive Assessment (MOCA). A total score of ≤ 25 indicated the presence of CI. We also performed the Clock Drawing Test (CDT) for cognitive status to evaluate the value of the CDT compared to the MOCA. In this test a score of less than 5 indicated the presence of CI. Depressive symptoms were assessed using the Geriatric Depression Scale (GDS). Information about hospital admissions, duration of HF, New York Heart Association (NYHA) class, risk factors and comorbidity were collected retrospectively from the electronic patients record system. Also, the attending physicians were asked to determine whether they thought the patient had either cognitive problems and/or a depression. We calculated the proportion of patients with CI, based on the MOCA and compared characteristics between groups with and without CI. We performed logistic regression analyses to assess the independent impact of a number of factors on the likelihood of a positive cognitive screening.
Results: A total of 101 patients were included. Their median age was 80 years and 63% were male. Ninety percent had NYHA functional class I or II. CI was present in 64 of 101 patients. Depression was present in 11 of 101 patients. Among the patients with CI, 31 of 64 (48.%) were recognized as such by physicians. This percentage was 67% in patients with a MOCA score ≤20. Depression was recognized in 4 of 11 patients (37%). The sensitivity of recognizing CI by physicians was 48%. Sensitivity of recognizing depression by physicians was 64%. This study did not show any significant differences between all hospital admissions or specific admissions related to HF and the presence of CI (p 0.21). Sensitivity and specificity of the CDT for CI compared to the MOCA was respectively 55% and 76%. Age (OR 1.2, 95%-CI 1.1-1.2, p<0.001, ) and years of education (OR 0.72, 95%-CI 0.6-0.9, p<0.001) appeared to be independent predictors of CI. Smoking appeared to be a protective factor for developing CI (OR 0.3, 95% CI 0.1-0.7).
Conclusion: CI and depression are present in a substantial number of older patients diagnosed with HF, yet it is infrequently recognized by physicians at the time of consultation. The presence of CI and depression and lack good recognition by health professionals may lead to a suboptimal treatment of HF.

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