Cognitive Function Does Not Impact Self-reported Health-Related Quality of Life in Heart Failure Patients

Abstract

Introduction Adults with heart failure (HF) often demonstrate impairment across multiple domains of cognitive functioning and report poor health-related quality of life (HRQoL). Surprisingly, cognitive deficits were generally not associated with HRQoL in a carefully evaluated sample (Pressler, Subramanian, & Kareken, 2010). The exception was memory, which was only weakly associated with HRQoL. However, cognitive deficits interfere with self-care and disease self-management, which could be expected to affect HRQoL. Objective We sought to verify this counter-intuitive finding in a large well-characterized sample of HF patients using a well-validated neuropsychological battery. Method Participants were 302 adults (63% male) predominately Caucasian (72.5%) HF patients (68.7 ± 9.6 years) recruited from two medical centers. Self-reported HRQoL was assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ). Participants completed a neuropsychological battery examining attention, executive function, memory, and visuospatial functioning. Hierarchical multiple linear regression was used for analyses. Results Mild global cognitive impairment was observed in 29.5% of the sample (Modified Mini-Mental State Examination score < 90). Controlling for gender, depression, HF severity, premorbid IQ, comorbidities, and education, only executive function predicted HRQoL, β = .17, p < .05. However, executive function only accounted for .6% of the variance in HRQoL. Conclusion Cognitive function generally did not predict HRQoL in HF patients, consistent with Pressler et al. (2010). The correlates of HRQoL in HF do not appear to include mild cognitive impairment. Other factors may play a bigger role such as disease severity, age and depressive symptoms (Pressler et al., 2010). Future studies should investigate modifiable determinants of HRQoL in HF patients, toward the goal of finding interventions that preserve HRQoL during this chronic illness.

Cognitive impairment, symptoms of depression, and health-related quality of life in patients with severe stable heart failure

“…Our research indicates that there is a close correlation between growing depression scale results and declining quality of life, both global and in all its dimensions in the HF group. This is consistent with the data available in the scientific literature ( Gathright et al, 2015 , Hwang et al, 2013 ). Meanwhile, in the cardiac control group the results of BDI-II correlated only with global and social QoL.…”

Cognitive performance is associated with worse prognosis in patients with heart failure with reduced ejection fraction

“…Our data show that both lower MoCA and KCCQ scores are predictors of MACE‐free survival. These results are in line with other studies showing that lower scores in MoCA and KCCQ are associated with poor health outcomes in adults with HF 27–31 . A possible explanation for this finding is that lower MoCA and KCCQ scores reflect greater severity of HF and consequently worst outcome; another explanation, especially for the predictive value of MoCA, is that mild CI may be associated with poorer self‐care and therapeutic compliance, although we did not explore this topic on our study.…”

Predicted relationships between cognitive function, depressive symptoms, self-care adequacy, and health-related quality of life and major events among patients with heart failure

“…6 In addition, impaired cognitive function in memory and executive function were associated with poor HRQL with minimum contributions. 16,17 Cognitive impairment assessed by healthcare providers was also significantly associated with major events. 15 The findings in this and prior studies suggest important roles of cognitive function in HRQL and major events in this population.…”