Journal of Cardiac Failure
Volume 16, Issue 9 , Pages 750-760 , September 2010

Memory Dysfunction, Psychomotor Slowing, and Decreased Executive Function Predict Mortality in Patients With Heart Failure and Low Ejection Fraction

  • Susan J. Pressler, RN, PhD

      Affiliations

    • University of Michigan School of Nursing, Ann Arbor, MI
    • Corresponding Author InformationReprint requests: Susan J. Pressler, RN, PhD, Professor, University of Michigan School of Nursing, 400 N. Ingalls, Ann Arbor, MI 48109. Tel: (734) 763-5650.
    • ,
  • Jinshil Kim, RN, PhD

      Affiliations

    • Ajou University School of Nursing, Suwon, South Korea
    • ,
  • Penny Riley, RN, MSN

      Affiliations

    • University of Michigan School of Nursing, Ann Arbor, MI
    • ,
  • David L. Ronis, PhD

      Affiliations

    • Director of Statistical Consulting Team, University of Michigan School of Nursing and Research Health Science Specialist, Department of Veterans Affairs, Ann Arbor, MI
    • ,
  • Irmina Gradus-Pizlo, MD

      Affiliations

    • Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN, and Clarian Advanced Heart Care Program, Indianapolis, IN

Received 5 October 2009 ,Revised 7 April 2010 ,Accepted 15 April 2010.

References 

  1. Lloyd-Jones D, Adams R, Carnethon M, DeSimone G, Ferguson TB, Flegal K, et al. Heart disease and stroke statistics – 2009 update: a report from the AHA Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;119:e21–181
  2. Sanderson JE, Tse T. Heart failure: a global disease requiring a global response. Heart. 2003;89:585–586
  3. Abraham WT, Fonarow GC, Albert NM, Stough WG, Gheorghiade M, Greenberg BH, et al. Predictors of in-hospital mortality in patients hospitalized for heart failure. J Am Coll Cardiol. 2008;52:347–356
  4. O'Connor CM, Abraham WT, Albert NM, Clare R, Stough WG, Gheorghiade M, et al. Predictors of mortality after discharge in patients hospitalized with heart failure: an analysis from the Optimized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). Am Heart J. 2008;156:662–673
  5. Goldberg RJ, Ciampa J, Lessard D, Meyer TE, Spencer FA. Long-term survival after heart failure: a contemporary population-based perspective. Arch Intern Med. 2007;167:490–496
  6. Levy WC, Mozaffarian D, Linker DT, Sutradher SC, Anker SD, Cropp AB, et al. The Seattle Heart Failure Model: prediction in survival of heart failure. Circulation. 2006;113:1424–1433
  7. Kosiborod M, Soto GE, Jones PG, Krumholz HM, Weintraub WS, Deedwania P, et al. Identifying heart failure patients at high risk for near-term cardiovascular events with serial health status assessments. Circulation. 2007;115:1975–1981
  8. Mommersteeg PMC, Denollet J, Spertus JA, Pedersen SS. Health status as a risk factor in cardiovascular disease: a systematic review of current evidence. Am Heart J. 2009;157:208–218
  9. Zuccala G, Pedone C, Cesari M, Onder G, Pahor M, Marzetti E, et al. The effects of cognitive impairment on mortality among hospitalized patients with heart failure. Am J Med. 2003;115:97–103
  10. Rozzini R, Sabatini T. Cognitive impairment and mortality in elderly patients with heart failure. Am J Med. 2004;116:137–138
  11. McLennan SN, Pearson SA, Cameron J, Stewart S. Prognostic importance of chronic heart failure patients: does specialist management make a difference?. Eur J Heart Fail. 2006;8:494–501
  12. Bennett SJ, Sauvé MJ. Cognitive deficits in patients with heart failure: a review of the literature. J Cardiovasc Nurs. 2003;18:219–242
  13. Pressler SJ. Cognitive functioning and chronic heart failure: a review of the literature (2002-July 2007). J Cardiovasc Nurs. 2008;23:239–249
  14. Vogels RL, Scheltens P, Schroeder-Tanka JM, Weinstein HC. Cognitive impairment in heart failure: a systematic review of the literature. Eur J Heart Fail. 2007;9:440–449
  15. Sauvé MJ, Lewis WR, Blankenbiller M, Rickabaugh B, Pressler SJ. Cognitive impairments in chronic heart failure: a case controlled study. J Card Fail. 2009;15:1–10
  16. Pressler SJ, Subramanian U, Perkins S, Kareken D, Gradus-Pizlo I, Sauvé MJ, et al. Cognitive deficits in chronic heart failure. Nurs Res. 2010;59:127–139
  17. Pullicino PM, Wadley YG, McClure LY, Safford MM, Lazar RM, Klapholz M, et al. Factors contributing to global cognitive impairment in heart failure: results from a population-based cohort. J Card Fail. 2008;14:290–295
  18. Bennett SJ, Huster GA, Baker SL, Milgrom LB, Kirchgassner A, Birt J, et al. Characterization of precipitants of hospitalization for heart failure decompensation. Am J Crit Care. 1998;7:168–174
  19. Murray MD, Young J, Hoke S, Tu W, Weiner M, Morrow D, et al. Pharmacist intervention to improve medication adherence in heart failure: a randomized trial. Ann Intern Med. 2007;146:714–725
  20. Jurgens CY, Hoke L, Byrnes J, Riegel B. Why do elders delay responding to heart failure symptoms?. Nurs Res. 2009;58:274–282
  21. Zuccala G, Onder G, Pedone C, Carosella L, Pahor M, Bernabei R, et al. Hypotension and cognitive impairment: selective association in patients with heart failure. Neurol. 2001;59:1986–1992
  22. Dickson VV, Tkacs N, Riegel B. Cognitive influences on self-care decision making in persons with heart failure. Am Heart J. 2007;154:424–431
  23. Bennett SJ, Sauvé MJ, Shaw RM. A conceptual model of cognitive deficits in chronic heart failure. J Nurs Scholarship. 2005;37:222–228
  24. Hachinski V, Iadecola C, Petersen RC, Breteler MM, Nyenhuis DL, Black SE, et al. National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards. Stroke. 2006;37:2220–2241
  25. Folstein MF, Folstein SE, McHugh PR. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198
  26. The Psychological Corporation. WechslerR Test of Adult Reading manual. San Antonio, TX: The Psychological Corporation; 2001;
  27. Kaplan EF, Goodglass H, Weintraub S. The Boston Naming Test. (2nd ed). Austin, TX: PRO ED Inc.; 2001;
  28. Wechsler D. Wechsler Adult Intelligence Scale (3rd ed.): Administration and scoring manual. San Antonio, TX: The Psychological Corporation; 1997.
  29. Brandt J, Benedict RHB. Hopkins verbal learning test – revised. Lutz, FL: Psychological Assessment Resources; 2001;
  30. Welsh KA, Butters N, Mohs RC, Beekly D, Edland S, Fillenbaum G, et al. The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part V. A normative study of the neuropsychological battery. Neurology. 1994;44:609–614
  31. Reitan RM. Trail Making Test. Tucson, AZ: Reitan Neuropsychological Laboratory; 1992;
  32. Benton AL, Hamsher K. deS. Multilingual aphasia exam manual. Iowa City: University of Iowa; 1978.
  33. New York Heart Association Criteria Committee. Disease of the heart and blood vessels: nomenclature and criteria for diagnosis. (6th ed). Boston: Little, Brown & Co; 1964;
  34. Hlatky MA, Boineau RE, Higginbotham MB, Lee KL, Mark DB, Califf RM, et al. A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). Am J Cardiol. 1989;64:651–654
  35. Carter R, Holiday DB, Grothues C, Nwasuruba C, Stocks J, Tiep B. Criterion validity of the Duke Activity Status Index for assessing functional capacity in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehab. 2002;22:298–308
  36. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383
  37. Chaudhry S, Jin L, Meltzer D. Use of a self-report-generated Charlson Comorbidity Index for predicting mortality. Med Care. 2005;43:607–615
  38. Perkins AJ, Kroenke K, Unutzer J, Katon W, Williams JW, Hope C, et al. Common comorbidity scales were similar in their ability to predict health care costs and mortality. J Clin Epidemiol. 2004;57:1040–1048
  39. Rutledge T, Reis VA, Linke SE, Greenberg BH, Mills PJ. Depression in heart failure: a meta-analytic review of prevalence, intervention effects, and association with clinical outcomes. J Am Coll Cardiol. 2006;48:1527–1537
  40. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–613
  41. Kroenke K, Spitzer RL. The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann. 2002;32:1–7
  42. Spitzer RL, Williams JB, Kroenke K, Hornyak R, McMurray J. Validity and utility of the PRIME-MD Patient Health Questionnaire in assessment of 3000 obstetric-gynecologic patients: the PRIME-MD Patient Health Questionnaire Obstetrics-Gynecology Study. Am J Obstet Gyn. 2000;183:759–769
  43. Rector TS, Francis GS, Cohn JN. Patients' self-assessment of their congestive heart failure. Part 1: patient perceived dysfunction and its poor correlation with maximal exercise tests. Heart Failure. 1987;3:192–196
  44. Rector TS, Kubo SH, Cohn JN. Patients' self-assessment of their congestive heart failure, Part 2: content, reliability and validity of a new measure, the Minnesota Living with Heart Failure Questionnaire. Heart Failure. 1987;3:198–209
  45. Tabachnick BG, Fidell LS. Using multivariate statistics. (5th ed). Boston: Pearson; 2007;
  46. Harrell FE, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15:361–387
  47. Hosmer DW, Lemeshow S. Applied logistic regression. 2nd ed.. New York, NY: Wiley; 2000;
  48. Harrell FE, Lee KL, Califf RM, Pryor DB, Rosati RA. Regression modelling strategies for improved prognostic prediction. Stat Med. 1984;3:143–152
  49. DeJager CA, Schrijnemaekers AMC, Honey TEM, Budge MM. Detection of MCI in the clinic: evaluation of the specificity and sensitivity of a computerised test battery, the Hopkins Verbal Learning test and the MMSE. Age Ageing. 2009;38:455–460
  50. Budson AE, Price BH. Memory dysfunction. N Engl J Med. 2005;352:692–699
  51. Budson AE. Understanding memory dysfunction. The Neurologist. 2009;15:71–79
  52. Leier CV. Regional blood flow in human congestive heart failure. Am Heart J. 1992;124:726–738
  53. Woo MA, Macey PM, Fonarow GC, Hamilton MA, Harper RM. Regional brain gray matter loss in heart failure. J Appl Physiol. 2003;95:677–684
  54. Kumar R, Woo MA, Birrer BVX, Macey PM, Fonarow GC, Hamilton MA, et al. Mammillary bodies and fornix fibers are injured in heart failure. Neurobiol Dis. 2009;33:236–242
  55. Woo MA, Kumar R, Macey PM, Fonarow GC, Harper RM. Brain injury in autonomic, emotional, and cognitive regulatory areas in patients with heart failure. J Card Fail. 2009;15:214–223
  56. Serber SL, Kumar R, Woo MA, Macey PM, Fonarow GC, Harper RM. Cognitive test performance and brain pathology. Nurs Res. 2008;57:75–83
  57. Vogels RLC, Oosterman JM, van Harten B, Gouw AA, Schroeder-Tanka JM, Scheltens P, et al. Neuroimaging and correlates of cognitive function among patients with heart failure. Dement Geriatr Cogn Disord. 2007;24:418–423
  58. Vogels RLC, Oosterman JM, Laman DM, Gouw AA, Schroeder-Tanka JM, et al. Transcranial Doppler blood flow assessment in patients with mild heart failure: correlates with neuroimaging and cognitive performance. Conges Heart Fail. 2008;14:61–65
  59. Siachos T, Vanbakel A, Feldman D, Uber W, Simpson KN, Pereira NL. Silent strokes in patients with heart failure. J Card Fail. 2005;11:485–489
  60. Raphael CE, Whinnett ZI, Davies JE, Fontana M, Ferenczi EA, Manisty CH, et al. Quantifying the paradoxical effect of higher systolic blood pressure on mortality in chronic heart failure. Heart. 2009;95:56–62
  61. Nussbaum PD, Allender J, Copeland J. Verbal learning in cardiac transplant candidates: a preliminary report. Int J Rehabil Health. 1995;1:5–12
  62. Zuccala G, Cattel C, Manes-Gravina E, DiNiro MG, Cocchi A, Bornabei R. Left ventricular dysfunction: a clue to cognitive impairment in older patients with heart failure. J Neurol Neurosurg Psychiatry. 1997;63:509–512
  63. Almeida OP, Tamai S. Congestive heart failure and cognitive function amongst older adults. Arq Neuropsiquiatr. 2001;59:324–329
  64. Jiang W, Kuchibhatla M, Clary GL, Cuffe M, Christopher J, Alexander R, et al. Relationships between depressive symptoms and long-term mortality in patients with heart failure. Am Heart J. 2007;154:102–108
  65. Sherwood A, Blumenthal JA, Trivedi R, Johnson KS, O'Connor CM, Adams KF, et al. Relationship of depression to death or hospitalization in patients with heart failure. Arch Int Med. 2007;167:367–373

 Funded by the National Institute of Nursing Research R01NR008147. Supported by the National Institute of Nursing Research. Institutions where work was done: Indiana University, Indianapolis, Indiana and University of Michigan, Ann Arbor, Michigan.

 See page 758 for disclosure information.

PII: S1071-9164(10)00197-1

doi: 10.1016/j.cardfail.2010.04.007

Journal of Cardiac Failure
Volume 16, Issue 9 , Pages 750-760 , September 2010

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