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Ren QW, Teng THK, Wang T, Tse YK, Wong PF, Li HL, Yu SY, Wu MZ, Li XL, Tse HF, Lam CSP, Yiu KH. Incidence, clinical correlates and associated outcomes of dementia in heart failure: a population-based cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Dementia, in the setting of heart failure (HF), portends poorer outcomes and poses great challenges in its clinical management.
Purpose
We investigated the incidence, types, clinical correlates, and the prognostic impact of dementia in a population-based cohort of patients with HF. Further, we examined the interactions of age and sex, and education status with dementia incidence.
Methods
The previously validated Hong Kong Clinical Data Analysis Reporting System (CDARS), a territory-wide database was interrogated to identify patients with HF (N= 202,121) from 1995 to 2018. Associations of clinical correlates with incident dementia and its risk with all-cause mortality were assessed using competing risk/multivariable Cox regression models where appropriate.
Results
Among a total cohort aged ≥18 years with HF (mean age: 75.3 ± 13.0 years, 51.3% women), new-onset dementia occurred in 22,145 (11.0%) over a median follow-up of 5.5 years. Alzheimer’s disease occurred in 27.0%; vascular dementia (18.1%) and unspecified dementia (in 55.1%). Age-standardized rate of dementia incidence in women was 1297 (95%CI, 1276-1318) (vs. 744, 95%CI, 723-765) per 10000 population in men. Other independent predictors of dementia include: Increasing age (HR 1.08), Female sex (HR 1.19), Nil/< primary (vs tertiary) education (HR 1.29), Parkinson’s disease (HR 1.73), head injury (HR 1.37), peripheral vascular disease (HR 1.31), stroke (HR 1.29), depression (HR 1.18), alcohol intake (HR1.17), anaemia (HR 1.14), hypertension (HR 1.08), among other common comorbidities in HF (Figure 1A).
Notably, a significant interaction (p < 0.001) between age and sex on dementia incidence was observed, such that women in all age groups were observed to have higher sHR compared to men (Figure 1B). After accounting for competing risk, dementia was not associated with adjusted hazard of all-cause mortality.
Conclusions
Female sex, lower socioeconomic status, increasing age and common comorbidities were associated with higher hazards of incident dementia. Abstract Figure 1A and Figure 1B
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Affiliation(s)
- Q W Ren
- The University of Hong Kong, Hong Kong, China
| | - T H K Teng
- National Heart Centre Singapore, Singapore, Singapore
| | - T Wang
- National Heart Centre Singapore, Singapore, Singapore
| | - Y K Tse
- The University of Hong Kong, Hong Kong, China
| | - P F Wong
- The University of Hong Kong, Hong Kong, China
| | - H L Li
- The University of Hong Kong, Hong Kong, China
| | - S Y Yu
- The University of Hong Kong, Hong Kong, China
| | - M Z Wu
- The University of Hong Kong, Hong Kong, China
| | - X L Li
- Nanjing Medical University, Nanjing, China
| | - H F Tse
- The University of Hong Kong, Hong Kong, China
| | - C S P Lam
- National Heart Centre Singapore, Singapore, Singapore
| | - K H Yiu
- The University of Hong Kong, Hong Kong, China
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