Cognitive Problems in Veterans With Heart Failure
We assessed the prevalence of cognitive/memory problems in veteran patients with heart failure, and evaluated its relationship to medication compliance.
|Study Design:||Observational Model: Cohort
Time Perspective: Prospective
|Official Title:||Cognitive Impairment as a Risk for the Admission-Readmission Cycle Seen in Veterans With Heart Failure: Closing the Adherence Gap|
- SLUMS scores (screening test for cognitive impairment) [ Time Frame: baseline collection ] [ Designated as safety issue: No ]
- association of cognitive impairment with medication adherence [ Time Frame: baseline collection ] [ Designated as safety issue: No ]
- association of cognitive impairment as measured by advanced neuropsychological testing, with medication adherence [ Time Frame: baseline collection ] [ Designated as safety issue: No ]
|Study Start Date:||February 2010|
|Study Completion Date:||April 2011|
|Primary Completion Date:||April 2011 (Final data collection date for primary outcome measure)|
veteran population with documented heart failure
Heart failure (HF) is a costly, chronic, and complex condition that impacts veterans' quality of life, morbidity, and mortality. In the VA population up to 20% of patients are readmitted for HF within 30 days. Non-adherence to prescribed medication and self-care regimens in patients with HF is known to lead to increased morbidity, including readmissions. Cognitive impairment (CI) has been shown to predict nonadherence in elderly people without HF, however, this link has not been studied in HF populations. In the non-veteran population, HF patients are known to have an increased prevalence of cognitive impairment (CI), however, no existing study has determined the extent and type of CI in veterans with HF.
This pilot study was designed as a descriptive cross-sectional study as a pre-implementation effort with following goals: (1) determine the prevalence of CI in veterans with all-cause HF in an outpatient setting; (2) quantitatively describe the extent of CI in this population; (3) qualitatively describe neuropsychological domains affected by CI; (4) evaluate the association of CI with medication adherence and other clinical variables.
All consenting eligible outpatients in our VA HF clinic underwent a simple screening test for CI (Saint Louis University Mental Status Exam). Demographic and clinical variables were collected by patient interviews and chartg reviews, and included Geriatric Depression Scale and questionnaires about medication-taking behaviors. All subjects were invited back for 30-day direct pill count of all their routinely prescribed medications. Subjects who screened positive for CI were invited back for a modified battery of neuropsychological tests to determine the cognitive domains affected. Subjects will also be followed after the 12-month study period to collect data on hospital readmissions.
In 251 patients, we found a startlingly high prevalence of undiagnosed CI (59%), with 35% of those impaired scoring in the 'dementia' range. CI correlated with medication adherence (r=0.24, p=0.004). On average, patients in our study were taking 8 prescription medications, and made a mistake in 20% of their doses (either took too many or too few pills). Subjects were as likely to "overtake" as "undertake" their medication, making this a significant patient safety issue. Subjects completing the neuropsychological testing (n=88) had most impairment in the domains of immediate and delayed verbal memory.
|United States, California|
|VA Medical Center, Loma Linda|
|Loma Linda, California, United States, 92357|
|Principal Investigator:||Helme Silvet, MD||VA Medical Center, Loma Linda|