Role of a multidisciplinary program in improving outcomes in cognitively impaired heart failure older patients

https://doi.org/10.4081/monaldi.2012.140

Authors

  • Donatella Del Sindaco | gipulig@yahoo.it Heart Failure Unit. Division of Cardiology, INRCA Institute of Care and Research for Elderly, Rome, Italy.
  • Giovanni Pulignano Heart Failure Clinic. Division of Cardiology/C.C.U. San Camillo Hospital, Rome, Italy.
  • Andrea Di Lenarda Cardiovascular Center and University, Trieste, Italy.
  • Luigi Tarantini Heart Failure Clinic. Division of Cardiology, San Martino Hospital, Belluno, Italy.
  • Giovanni Cioffi Heart Failure Clinic. Division of Cardiology, Villa Bianca Hospital, Trento, Italy.
  • Stefano Tolone Heart Failure Clinic. Division of Cardiology/C.C.U. San Camillo Hospital, Rome, Italy.
  • Maria Denitza Tinti Heart Failure Clinic. Division of Cardiology/C.C.U. San Camillo Hospital, Rome, Italy.
  • Luca Monzo Heart Failure Clinic. Division of Cardiology/C.C.U. San Camillo Hospital, Rome, Italy.
  • Giulia Barbati Department of Medical Sciences, University of Trieste, Italy.
  • Giovanni Minardi Heart Failure Clinic. Division of Cardiology/C.C.U. San Camillo Hospital, Rome, Italy.

Abstract

Background: Cognitive impairment (CI) frequently complicates Heart failure (HF) and is associated with increased mortality and morbidity. Previous studies reported that nurse-lead home-based multidisciplinary program (MP) may not improve the prognosis of this high-risk group. In the present study, we analysed the relative effectiveness of an integrated hospital-based MP in patients with cognitive impairment. Methods: Consecutive (n=173) community-living outpatients aged >70 years (mean 77+6, 48% women) randomized to a MP (n=86) or usual care (UC) (n=87) were enrolled in stable clinical conditions. Cognitive status was assessed by means of Folstein Mini Mental State Examination (MMSE). Results: CI (MMSE<24) was present in 41.6% (42,5% UC vs 40.7% MP p=ns). The variables independently associated to CI were: older age, education level <5 years, anemia and severe renal dysfunction. During a 2-year follow-up, 59 patients died (31.4%) with no significant difference between intervention group. At multivariate analysis, in the entire cohort, CI was independently associated to death (HR 2,077[95%CI 1,097- 3,931]), HF admissions (2,133[1,346-3,381]), death/HF admissions (1,784[1,132-2,811]) and all-cause admissions (1,473[1,008-2,153]. When considered according to intervention groups, CI was independently associated to all-cause death (3,603 [1,553-8,358], death/HF admissions (2,029[1,200-3,432]) and HF admissions (2,474[1,406-4,353]) but not to all-cause admissions. The assignment of patients with CI to MP was associated to a significant reduction in HF admissions vs UC (0,503[0,253-0,999] (all interaction tests p=ns). Conclusions: This study suggests that CI is very common and associated to worse prognosis in heart failure and that hospital-based MP seems to improve outcomes in these patients through reduction of heart failure hospital admission.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Downloads

Published
2015-12-03
Info
Issue
Section
Original Articles
Keywords:
heart failure, disease management, cognitive impairment, elderly, prognosis.
Statistics
  • Abstract views: 795

  • PDF: 469
How to Cite
Del Sindaco, Donatella, Giovanni Pulignano, Andrea Di Lenarda, Luigi Tarantini, Giovanni Cioffi, Stefano Tolone, Maria Denitza Tinti, Luca Monzo, Giulia Barbati, and Giovanni Minardi. 2015. “Role of a Multidisciplinary Program in Improving Outcomes in Cognitively Impaired Heart Failure Older Patients”. Monaldi Archives for Chest Disease 78 (1). https://doi.org/10.4081/monaldi.2012.140.

Most read articles by the same author(s)