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Trullàs JC, Moreno-García MC, Mittelbrunn-Alquézar V, Conde-Martel A, Soler-Rangel L, Montero-Pérez-Barquero M, Casado J, Sánchez-Marteles M, Arévalo-Lorido JC, Pérez-Silvestre J. The RICA-2 registry: Design and baseline characteristics of the first 1,000 patients. Rev Clin Esp 2024:S2254-8874(24)00102-4. [PMID: 39053884 DOI: 10.1016/j.rceng.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 06/25/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND AND OBJECTIVE Heart failure (HF) is a syndrome of epidemic proportions and one of the main reasons for hospital admission. Patient registries provide real-world clinical practice information which is complementary to clinical trials. RICA-2 is a registry of the Spanish Society of Internal Medicine. Its main goal is to know the clinical and epidemiological characteristics and prognostic factors of patients with HF treated in Internal Medicine Departments. The objective of this study is to present the design of the RICA-2, the baseline characteristics of the first 1000 patients included and their comparison with those of the historical cohort of the RICA registry. METHODS Observational, multicentre and prospective study of patients with HF with the following inclusion criteria: age equal to or greater than 18 years old, diagnosis of HF according to the European Guidelines, indistinct inclusion in decompensation or stable phase, of patients with "de novo" HF or chronic HF, regardless of left ventricular ejection fraction, aetiology and comorbidities. RESULTS RICA-2 patients have advanced age (83 years old) and 51% are women. The comorbidity burden is higher than in the RICA registry (5 points in the Charlson comorbidity index), with predominating chronic decompensated HF (74%), hypertensive aetiology (39%) and preserved ejection fraction (52%). Most patients are pre-frail or vulnerable and are at risk of malnutrition. CONCLUSION The RICA-2 represents a contemporary cohort of patients that will provide us with clinical, epidemiological and prognostic information on patients with acute and chronic HF treated in Internal Medicine.
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Affiliation(s)
- J C Trullàs
- Servicio de Medicina Interna, Hospital d'Olot i Comarcal de La Garrotxa, Girona, Catalonia, Spain; Tissue Repair and Regeneration Laboratory (TR2Lab), Institut de Recerca i Innovació en Ciències de La Vida i de La Salut a La Catalunya Central (IrisCC), Barcelona, Spain.
| | | | | | - A Conde-Martel
- Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain; Facultad de Ciencias de la Salud, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - L Soler-Rangel
- Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, FIIB HUIS HHEN, Madrid, Spain
| | | | - J Casado
- Servicio de Medicina Interna, Hospital Universitario de Getafe, Madrid, Spain
| | - M Sánchez-Marteles
- Servicio de Medicina Interna, Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - J C Arévalo-Lorido
- Servicio de Medicina Interna, Hospital Universitario de Badajoz, Badajoz, Spain
| | - J Pérez-Silvestre
- UMIPIC, Servicio de Medicina Interna, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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2
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Miao F, Tian A, Wang B, Li J. Cognitive impairment in young and middle-aged patients with acute heart failure. ESC Heart Fail 2024. [PMID: 38816208 DOI: 10.1002/ehf2.14885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/15/2024] [Accepted: 05/11/2024] [Indexed: 06/01/2024] Open
Abstract
AIMS This study aimed to investigate the prevalence, risk factors and prognostic implications of cognitive impairment in young and middle-aged patients with acute heart failure (HF). METHODS In a prospective cohort of patients with acute HF, we assessed cognitive function by the Mini-Cog, predictors of the cognitive impairment and its associations with 30 day and 1 year cardiovascular death or HF rehospitalization among young and middle-aged patients (<65 years old). RESULTS Among 1958 young and middle-aged patients, the prevalence of cognitive impairment was 19.6%. Predictors of cognitive impairment included older age, females, lower education levels and prior strokes. Compared with patients having normal cognitive function, cognitive impairment was associated with a higher risk of 30 day cardiovascular death or HF rehospitalization [hazard ratio (HR), 1.52, 95% confidence interval (CI), 1.07-2.17, P = 0.02], but not for 1 year cardiovascular death or HF rehospitalization (HR, 1.06, 95% CI, 0.87-1.30, P = 0.55). CONCLUSIONS Cognitive impairment is present in a notable proportion of young and middle-aged patients with acute HF and is associated with an increased risk of short-term adverse outcomes. Strategies for screening and intervention for cognitive impairment at a younger age are necessary, particularly for those at high risk.
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Affiliation(s)
- Fengyu Miao
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, People's Republic of China
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, People's Republic of China
- Beijing Municipal Health Big Data and Policy Research Center, Beijing Institute of Hospital Management, Beijing, People's Republic of China
| | - Aoxi Tian
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, People's Republic of China
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, People's Republic of China
| | - Bin Wang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, People's Republic of China
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, People's Republic of China
| | - Jing Li
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, People's Republic of China
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, People's Republic of China
- Central-China Branch of National Center for Cardiovascular Diseases, Central-China Hospital, Zhengzhou, People's Republic of China
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3
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Park MS, Kim EJ. A Correlative Relationship Between Heart Failure and Cognitive Impairment: A Narrative Review. J Korean Med Sci 2023; 38:e334. [PMID: 37821090 PMCID: PMC10562184 DOI: 10.3346/jkms.2023.38.e334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/11/2023] [Indexed: 10/13/2023] Open
Abstract
Heart failure (HF) is a chronic condition affecting millions of people worldwide. While the cardinal manifestations of HF are related to the cardiovascular system, it has become progressively evident that mild cognitive impairment (MCI) is also a significant complication of the disease. In fact, a significant number of patients with HF may experience MCI, which can manifest as deficits in attention, memory, executive function, and processing speed. The mechanisms responsible for cognitive dysfunction in HF are intricate and multifactorial. Possible factors contributing to this condition include decreased cerebral blood flow, thrombogenicity associated with HF, systemic inflammatory conditions, and proteotoxicity. MCI in HF has significant clinical implications, as it is linked to poorer quality of life, increased morbidity and mortality, and higher healthcare costs. Additionally, MCI can disrupt self-care behaviors, adherence to medication, and decision-making abilities, all of which are crucial for effectively managing HF. However, there is currently no gold standard diagnostic tool and follow-up strategy for MCI in HF patients. There is limited knowledge on the prevention and treatment of MCI. In conclusion, MCI is a common and clinically important complication of HF. Considering the substantial influence of MCI on patient outcomes, it is imperative for healthcare providers to be cognizant of this issue and integrate cognitive screening and management strategies into the care of HF patients.
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Affiliation(s)
- Myung Soo Park
- Department of Medicine, Korea University Graduate School, Seoul, Korea
- Division of Cardiology, Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Eung Ju Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
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4
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Wu Y, Chen L, Zhong F, Zhou K, Lu C, Cheng X, Wang S. Cognitive impairment in patients with heart failure: molecular mechanism and therapy. Heart Fail Rev 2023:10.1007/s10741-022-10289-9. [PMID: 36593370 DOI: 10.1007/s10741-022-10289-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 01/04/2023]
Abstract
Heart failure (HF) is associated with multiple organ dysfunction and many comorbidities. Its incidence is high among the elderly and is a major health burden worldwide. Cognitive impairment (CI) is highly prevalent in older patients with HF, which is an abnormality in one or more of the items of cognition, attention, memory, language, psychomotor function, and visual spatial acuity. Studies have shown that the incidence of CI in HF patients is between 13 and 54%, and patients with both conditions have poor self-care ability and prognosis, as well as increased mortality rates. However, the mechanisms of CI development in HF patients are still unclear. In this review, we describe the epidemiology and risk factors as well as measures of improving CI in HF patients. We update the latest pathophysiological mechanisms related to the neurocognitive changes in HF patients, expounding on the mechanisms associated with the development of CI in HF patients.
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Affiliation(s)
- Yanan Wu
- Department of Anesthesiology, School of Medicine, South China University of Technology, Guangzhou, 510006, China
- Department of Anesthesiology, Guangdong Province, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Liwen Chen
- Department of Anesthesiology, Guangdong Province, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Feng Zhong
- Department of Anesthesiology, Guangdong Province, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Kaiyi Zhou
- Department of Anesthesiology, School of Medicine, South China University of Technology, Guangzhou, 510006, China
- Department of Anesthesiology, Guangdong Province, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Chao Lu
- Department of Anesthesiology, Guangdong Province, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Xiao Cheng
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Sheng Wang
- Department of Anesthesiology, School of Medicine, South China University of Technology, Guangzhou, 510006, China.
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
- Department of Anesthesiology, Guangdong Province, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China.
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5
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Cognitive Dysfunction in Heart Failure: Pathophysiology and Implications for Patient Management. Curr Heart Fail Rep 2022; 19:303-315. [PMID: 35962923 DOI: 10.1007/s11897-022-00564-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE OF REVIEW There is increasing recognition of the prevalence and impact of cognitive dysfunction (CD) in heart failure (HF) patients. This contemporary review appraises the evidence for epidemiological association, direct pathophysiological links and emerging pharmacological and non-pharmacological interventions. Furthermore, we present evidence for care models that aim to mitigate the morbidity and poor quality of life associated with these dual processes and propose future work to improve outcomes. RECENT FINDINGS CD disproportionately affects heart failure patients, even accounting for known comorbid risk factors, and this may extend to subclinical left ventricular dysfunction. Neuroimaging studies now provide evidence of anatomical and functional differences which support previously postulated mechanisms of reduced cerebral blood flow, micro-embolism and systemic inflammation. Interventions such as multidisciplinary ambulatory HF care, education and memory training improve HF outcomes perhaps to a greater degree in those with comorbid CD. Additionally, optimisation of standard heart failure care (cardiac rehabilitation, pharmacological and device therapy) may lead to additional cognitive benefits. Epidemiological, neuroimaging and intervention studies provide evidence for the causal association between HF and CD, although evidence for Alzheimer's dementia is less certain. Specific reporting of cognitive outcomes in HF trials and evaluation of targeted interventions is required to further guide care provision.
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6
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Zhang H, Jie Y, Sun Y, Wang X, Gong D, Fan Y. Association of cognitive impairment with mortality and readmission in patients with heart failure: A meta-analysis. Curr Probl Cardiol 2022; 47:101354. [PMID: 35970299 DOI: 10.1016/j.cpcardiol.2022.101354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/05/2022] [Accepted: 08/07/2022] [Indexed: 12/01/2022]
Abstract
Cognitive impairment is a frequent condition in patients with heart failure (HF). This meta-analysis aimed to evaluate the prognostic impact of cognitive impairment on all-cause mortality and readmission among HF patients. We systematically searched articles indexing in PubMed and Embase databases until August 5, 2022. Original studies investigating the association of cognitive impairment with mortality and/or readmission for more than 3-month follow-up in patients with HF were selected. Twelve studies including 9556 patients were eligible. The prevalence of cognitive impairment ranged from 13.5% to 63.4% in HF patients. For patients with cognitive impairment versus those without, the pooled adjusted risk ratio (RR) was 1.88 (95% confidence intervals [CI] 1.42-2.48) for all-cause mortality, 1.48 (95% CI 1.19-1.84) for readmission, and 1.53 (95% CI 1.35-1.73) for combined endpoints of all-cause mortality/readmission, respectively. Cognitive impairment is a significant predictor of all-cause mortality/readmission in patients with HF, even after adjustment for the conventional confounding. Evaluation of cognitive function may help to improve risk classification of HF patients.
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Affiliation(s)
- Hailing Zhang
- Center of Clinical Medical Research, The Affiliated Suqian First People's Hospital of Xuzhou Medical University, Suqian, Jiangsu, China (223800)
| | - Yu Jie
- Institute of Molecular Biology & Translational Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, China (212002)
| | - Yimeng Sun
- Institute of Molecular Biology & Translational Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, China (212002)
| | - Xiaoyan Wang
- Center of Clinical Medical Research, The Affiliated Suqian First People's Hospital of Xuzhou Medical University, Suqian, Jiangsu, China (223800).
| | - Dandan Gong
- Institute of Molecular Biology & Translational Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, China (212002).
| | - Yu Fan
- Institute of Molecular Biology & Translational Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, China (212002).
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7
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Yap NLX, Kor Q, Teo YN, Teo YH, Syn NL, Mance Evangelista LK, Tan BY, Lin W, Yeo LL, Kong WK, Chong YF, Wong RC, Poh KK, Yeo TC, Sharma VK, Chai P, Chan MY, Goh FQ, Sia CH. Prevalence and Incidence of Cognitive Impairment and Dementia in Heart Failure - A Systematic Review, Meta-Analysis and Meta-Regression. Hellenic J Cardiol 2022; 67:48-58. [PMID: 35839985 DOI: 10.1016/j.hjc.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/14/2022] [Accepted: 07/07/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The burden of cognitive impairment in HF patients is significant and leads to longer hospital stay, higher readmission rates, and increased mortality. This review seeks to synthesize the available studies to determine the prevalence and incidence of cognitive impairment and dementia in HF patients. METHODS PubMed, Embase, PsychoINFO and Cochrane databases were systematically searched from their inception through to 3 May 2021. Study and population characteristics, total patients with HF, prevalence of cognitive impairment and dementia in HF patients and cognitive assessment tool were abstracted by two reviewers. RESULTS In heart failure patients, overall prevalence for cognitive impairment and dementia was 41.42% (CI) and 19.79% (dementia) respectively. We performed a meta-regression analysis which demonstrated that the risk of cognitive impairment and dementia increased with age. DISCUSSION Further research should investigate whether HF accelerates the rate of cognitive decline and the progression of dementia.
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Affiliation(s)
- Nicole Li Xian Yap
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228
| | - Qianyi Kor
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228
| | - Yao Neng Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228
| | - Yao Hao Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228
| | - Nicholas L Syn
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228
| | - Lauren Kay Mance Evangelista
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228
| | - Benjamin Yq Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228; Division of Neurology, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074
| | - Weiqin Lin
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228; Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228
| | - Leonard Ll Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228; Division of Neurology, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074
| | - William Kf Kong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228; Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228
| | - Yao Feng Chong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228; Division of Neurology, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074
| | - Raymond Cc Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228; Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228
| | - Kian Keong Poh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228; Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228
| | - Tiong-Cheng Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228; Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228
| | - Vijay Kumar Sharma
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228; Division of Neurology, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074
| | - Ping Chai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228; Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228
| | - Mark Y Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228; Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228
| | - Fang Qin Goh
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228; Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228.
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Ventoulis I, Arfaras-Melainis A, Parissis J, Polyzogopoulou E. Cognitive Impairment in Acute Heart Failure: Narrative Review. J Cardiovasc Dev Dis 2021; 8:jcdd8120184. [PMID: 34940539 PMCID: PMC8703678 DOI: 10.3390/jcdd8120184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/11/2021] [Accepted: 12/12/2021] [Indexed: 12/03/2022] Open
Abstract
Cognitive impairment (CI) represents a common but often veiled comorbidity in patients with acute heart failure (AHF) that deserves more clinical attention. In the AHF setting, it manifests as varying degrees of deficits in one or more cognitive domains across a wide spectrum ranging from mild CI to severe global neurocognitive disorder. On the basis of the significant negative implications of CI on quality of life and its overwhelming association with poor outcomes, there is a compelling need for establishment of detailed consensus guidelines on cognitive screening methods to be systematically implemented in the population of patients with heart failure (HF). Since limited attention has been drawn exclusively on the field of CI in AHF thus far, the present narrative review aims to shed further light on the topic. The underlying pathophysiological mechanisms of CI in AHF remain poorly understood and seem to be multifactorial. Different pathophysiological pathways may come into play, depending on the clinical phenotype of AHF. There is some evidence that cognitive decline closely follows the perturbations incurred across the long-term disease trajectory of HF, both along the time course of stable chronic HF as well as during episodes of HF exacerbation. CI in AHF remains a rather under recognized scientific field that poses many challenges, since there are still many unresolved issues regarding cognitive changes in patients hospitalized with AHF that need to be thoroughly addressed.
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Affiliation(s)
- Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, 50200 Ptolemaida, Greece
- Correspondence: or (I.V.); (A.A.-M.); Tel.: +30-6973018788 (I.V.); +1-347-920-8875 (A.A.-M.)
| | - Angelos Arfaras-Melainis
- Heart Failure Unit and University Clinic of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, 12462 Athens, Greece; (J.P.); (E.P.)
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Correspondence: or (I.V.); (A.A.-M.); Tel.: +30-6973018788 (I.V.); +1-347-920-8875 (A.A.-M.)
| | - John Parissis
- Heart Failure Unit and University Clinic of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, 12462 Athens, Greece; (J.P.); (E.P.)
| | - Eftihia Polyzogopoulou
- Heart Failure Unit and University Clinic of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, 12462 Athens, Greece; (J.P.); (E.P.)
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Tanaka S, Yamashita M, Saito H, Kamiya K, Maeda D, Konishi M, Matsue Y. Multidomain Frailty in Heart Failure: Current Status and Future Perspectives. Curr Heart Fail Rep 2021; 18:107-120. [PMID: 33835397 DOI: 10.1007/s11897-021-00513-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW With a worldwide aging population, frailty and heart failure (HF) have become issues that need to be addressed urgently in cardiovascular clinical practice. In this review, we outline the clinical implications of frailty in HF patients and the potential therapeutic strategies to improve the clinical outcomes of frail patients with HF. RECENT FINDINGS Frailty has physical, psychological, and social domains, each of which is a prognostic determinant for patients with HF, and each domain overlaps with the other, although there are no standardized criteria for diagnosing frailty. Frailty can be targeted for treatment with various interventions, and recent studies have suggested that multidisciplinary intervention could be a promising option for frail patients with HF. However, currently, there is limited data, and further research is needed before its clinical implementation. Frailty and HF share a common background and are strongly associated with each other. More comprehensive assessment and therapeutic interventions for frailty need to be developed to further improve the prognosis and quality of life of frail patients with HF.
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Affiliation(s)
- Shinya Tanaka
- Department of Rehabilitation, Nagoya University Hospital, Aichi, Japan
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
| | - Hiroshi Saito
- Department of Rehabilitation, Kameda Medical Center, Chiba, Japan.,Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Daichi Maeda
- Department of Cardiology, Osaka Medical College, Osaka, Japan
| | - Masaaki Konishi
- Division of Cardiology, Yokohama City University Medical Center, Kanagawa, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. .,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
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10
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Cecchi E, Pedone C. "Cardiovascular dementia" reappraisal of an old concept and Giambattista Vico's course and recourse theory: is history repeating itself? Intern Emerg Med 2021; 16:29-31. [PMID: 32683641 DOI: 10.1007/s11739-020-02437-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Enrica Cecchi
- Emergency Department, Azienda USL Toscana Centro, Nuovo Ospedale S. Stefano, Via Suor Niccolina Infermiera, 20, 59100, Prato, Italy.
| | - Claudio Pedone
- Unit of Geriatrics, Campus Bio-Medico University, via Alvaro del Portillo 21, 00128, Rome, Italy
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