Cognitive function in ambulatory patients with systolic heart failure: insights from the warfarin versus aspirin in reduced cardiac ejection fraction (WARCEF) trial

PLoS One. 2014 Nov 26;9(11):e113447. doi: 10.1371/journal.pone.0113447. eCollection 2014.

Abstract

We sought to determine whether cognitive function in stable outpatients with heart failure (HF) is affected by HF severity. A retrospective, cross-sectional analysis was performed using data from 2, 043 outpatients with systolic HF and without prior stroke enrolled in the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) Trial. Multivariable regression analysis was used to assess the relationship between cognitive function measured using the Mini-Mental Status Exam (MMSE) and markers of HF severity (left ventricular ejection fraction [LVEF], New York Heart Association [NYHA] functional class, and 6-minute walk distance). The mean (SD) for the MMSE was 28.6 (2.0), with 64 (3.1%) of the 2,043 patients meeting the cut-off of MMSE <24 that indicates need for further evaluation of cognitive impairment. After adjustment for demographic and clinical covariates, 6-minute walk distance (β-coefficient 0.002, p<0.0001), but not LVEF or NYHA functional class, was independently associated with the MMSE as a continuous measure. Age, education, smoking status, body mass index, and hemoglobin level were also independently associated with the MMSE. In conclusion, six-minute walk distance, but not LVEF or NYHA functional class, was an important predictor of cognitive function in ambulatory patients with systolic heart failure.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Age Factors
  • Aged
  • Aspirin / therapeutic use*
  • Body Mass Index
  • Cognition*
  • Cross-Sectional Studies
  • Educational Status
  • Exercise Tolerance
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Heart Failure, Systolic / diagnosis
  • Heart Failure, Systolic / drug therapy*
  • Heart Failure, Systolic / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Outpatients
  • Retrospective Studies
  • Severity of Illness Index
  • Smoking / physiopathology
  • Stroke Volume
  • Ventricular Function, Left
  • Walking
  • Warfarin / therapeutic use*

Substances

  • Fibrinolytic Agents
  • Warfarin
  • Aspirin