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Table 2 Studies examining cognitive changes over time in the heart failure population

From: ‘Hearts and minds’: association, causation and implication of cognitive impairment in heart failure

Study

Sample

Population

Median age in years (SD)

Study methodology

Inclusion criteria

Exclusion criteria

CV measures

Cognitive assessment tool used

Follow-up period

Results

Karlsson 2005 [32]

146 CHF pts

Age >60 years and outpatients

76 (8)

Prospective

EF <45%

Co-morbid psychiatric, neurological or physical illness. Previous diagnosis of CI

LVEF

MMSE

6 months

12% of HF patients had MMSE scores <24 at baseline

NYHA II-IV

NYHA

And 4% had MMSE scores <24 at 6 months

Tanne 2005 [33]

20 CHF underwent exercise programme

5 CHF pts as control pts

Outpatients

63 (13)

Prospective

EF ≤35%

Co-morbid psychiatric, neurological or physical illness

LVEF

Multidomain neuropsychiatric battery

18 weeks

Improvement in executive function post-exercise programme

NYHA III

NYHA

History of HF for ≥6 months

Mod-Bruce ETT

No change in cognition in control group with time

Stable on medication ≥6 weeks

6 minute walk test

Stanek 2009 [19]

40 HF pts, 35 CAD controls

Age >53 and <84 years. Outpatients

70 (8)

Prospective

HF: English speaking

Co-morbid psychiatric or neurological illness. Previous diagnosis of CI

NYHA

DRS

12 months

HF patients improved at 12 months, particularly in attention

NYHA II or III

CO <4 L/minute

CO

Cardiac controls stable at 12 months

CAD controls: CO ≥4 L/minute, history of MI/CAD

Almeida 2013 [34]

77 HF pts

Age >45 years and outpatients

HF: 68 (10)

Prospective

HF: EF <40%, English speaking

Co-morbid psychiatric or neurological illness. Previous diagnosis of CI

NYHA

Multidomain neuropsychiatric battery

2 years

CHF group showed cognitive decline compared with CAD and healthy controls

73 CAD controls

CAD controls: 68 (10)

CAD controls: previous MI and EF >60%, English speaking

LVEF

81 healthy controls

Healthy controls: 69 (11)

Healthy controls: no history of CAD, English speaking

6 minute walk test

Hjelm 2011 [35]

95 HF pts

607 non-CHF controls

Age >80 years and outpatients

84 (3)

Prospective

Not specified

Not specified

HF diagnosis based on documentation in medical records

Multidomain neuropsychiatric battery

10 years

HF patients showed significant decline in episodic memory and spatial performance compared with controls

Riegel 2012 [36]

279 consecutive HF pts (HF-REF and HF-PEF)

Age <80 years and outpatients

62 (12)

Prospective

Stage C HF and English speaking

Co-morbid psychiatric or physical illness. Previous diagnosis of CI

NYHA I-IV

Multidomain neuropsychiatric battery

6 months

No significant change in cognition over 6 months (HF-REF and HF-PEF)

LVEF

Minimal improvement in DSST in both groups (likely due to learned effect)

Higher LVEF associated with lower DSST score

Huijts 2013 [30]

491 HF-REF

120 HF-PEF

Age >60 years and outpatients

77 (8)

Prospective

HF-REF: hospitalization within past year

Co-morbid physical illness

HF-REF: LVEF <45%, NYHA II-IV, NT-proBNP >400 pg/ml

AMT

18 months

HF-REF: 23% of HF pts showed decline of ≥1 point in AMT over 18 months

HF-PEF: NT-proBNP ≥400 pg/ml if pt <75 years or ≥800 pg/ml if pt ≥75 years

120 HF-PEF: LVEF ≥45%

HF-PEF: 24% of HF pts showed improvement of ≥1 point in AMT over 18 months

  1. AMT, Abbreviated Mental Test; CAD, coronary artery disease; CHF, congestive heart failure; CI, cognitive impairment; CO, cardiac output; CV, cardiovascular; DRS, Disability Rating Scale; DSST, digit symbol substitution test; EF, ejection fraction; ETT, exercise tolerance test; HF, heart failure; HF-REF, heart failure-reduced ejection fraction; HF-PEF, heart failure-preserved ejection fraction; LVEF, left ventricular ejection fraction; MI, myocardial infarction; MMSE, Mini-Mental State Examination; NT-pro BNP, N-terminal prohormone brain natriuretic peptide; NYHA, New York Heart Association; pts, patients; SD, standard deviation.