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. 2019 Oct;31(4):170-178.
doi: 10.1016/j.jsha.2019.06.001. Epub 2019 Jun 18.

Cognitive impairment associated with increased mortality rate in patients with heart failure: A systematic review and meta-analysis

Jakrin Kewcharoen  1   2 , Narut Prasitlumkum  1 , Chanavuth Kanitsoraphan  1 , Nattawat Charoenpoonsiri  2 , Natthapon Angsubhakorn  3 , Prapaipan Putthapiban  4 , Pattara Rattanawong  1   5
Affiliations

Cognitive impairment associated with increased mortality rate in patients with heart failure: A systematic review and meta-analysis

Jakrin Kewcharoen et al. J Saudi Heart Assoc. 2019 Oct.

Abstract

Background: Recent systematic review and meta-analysis showed that the prevalence of cognitive impairment was significantly increased in patients with heart failure (HF) when compared to the general population. However, the effect of cognitive impairment on cardiovascular outcome in this population is still unclear. We performed a systematic review and meta-analysis to assess whether cognitive impairment associated with worse outcome in patients with HF.

Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to October 2018. Included studies were published cohort (prospective or retrospective) or randomized control trials that evaluate the effect of cognitive impairment mortality in HF patients. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate pooled hazard ratios (HR) and 95% confidence intervals (CI).

Results: Eight studies were included in the analysis involving 3318 participants (951 participants had cognitive impairment). In a random-effects model, our analysis demonstrated that cognitive impairment significantly increased the risk of mortality in HF patients (pooled HR = 1.64, 95% CI = 1.42-1.88, I2 = 0.0%, p < 0.001).

Conclusion: Our systematic review and meta-analysis showed that the presence of cognitive impairment is strongly associated with an increased mortality risk in the HF population. Further research is needed to explore the pathophysiology of this association.

Keywords: Cognitive dysfunction; Heart failure; Mortality.

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Figures

Figure 1
Figure 1
PRISMA flow diagram demonstrating search strategy and selection process.
Figure. 2
Figure. 2
Forest plot of included studies assessing the association between cognitive impairment and mortality rate in patients with heart failure. CI = confidence interval; HR = hazard ratio.
Figure. 3
Figure. 3
Funnel plot of cognitive impairment and mortality. Circles represent published studies. HR = hazard ratio.
Figure. 4
Figure. 4
Egger’s test. CI = confidence interval, SND = Standardized.
Figure. 5
Figure. 5
Subgroup analysis of studies with adjusted hazard ratio of cognitive impairment and mortality rate in patients with heart failure. CI = confidence interval.
Supplementary file 1
Supplementary file 1
See this image and copyright information in PMC

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