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Cognitive Problems in Veterans With Heart Failure

2014-07-23 21:11:07 | BioPortfolio

Summary

We plan to assess the prevalence of cognitive/memory problems in veteran patients with heart failure, and evaluate its relationship to medication compliance.

Description

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, and the CHF QUERI's 2008 Strategic Plan ranks lowering readmission rates as the highest in priority of clinical issues to be addressed.

Non-adherence to prescribed medication and self-care regimens in patients with heart failure is well known to lead to increased morbidity, including readmissions. Despite multiple modalities of patient education there remains a failure on the part of many patients in our outpatient HF clinic to adhere to even a carefully individualized plan of care. We have termed this care deficit the "patient adherence gap".

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. There are also no published data sufficiently evaluating the link between CI and adherence or the link between CI and readmissions in heart failure populations.

To address this need, we have designed a descriptive cross-sectional study as a pre-implementation effort. We hypothesize that the presence of CI negatively impacts adherence and contributes to the patient adherence gap, which in turn results in increased readmissions for HF. Goals of this pilot study are to: (1) evaluate the association of CI with adherence (measured by compliance with medications); (2) determine the prevalence of CI in veterans with all-cause HF in an outpatient setting; (3) quantitatively describe the extent of CI in this population; (4) qualitatively describe neuropsychological domains affected by CI.

To accomplish these goals, all consenting eligible outpatients in our VA HF clinic will undergo a simple screening test for CI (SLUMS). We will also interview the patients to collect demographic and clinical data, and to rate them on the geriatric depression scale. If the subjects screen positive for CI, they will undergo further evaluation by a battery of neuropsychological tests. Adherence will be evaluated by a direct 30 day pill count, a brief questionnaire measuring intentional nonadherence, and a review of pharmacy refill records. We will follow patients after the 12-month study period to collect data on hospital readmissions.

Results from our study will test the feasibility and utility of screening for CI in outpatient HF population, using simple and cost-effective tools. It will also provide valuable data to support our future intervention trial assessing the impact of CI intervention on outcomes, such as improved adherence and reduced admissions.

Study Design

Observational Model: Cohort, Time Perspective: Prospective

Conditions

Heart Failure

Location

VA Medical Center, Loma Linda
Loma Linda
California
United States
92357

Status

Recruiting

Source

Department of Veterans Affairs

Results (where available)

View Results

Links

Published on BioPortfolio: 2014-07-23T21:11:07-0400

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Medical and Biotech [MESH] Definitions

A heterogeneous condition in which the heart is unable to pump out sufficient blood to meet the metabolic need of the body. Heart failure can be caused by structural defects, functional abnormalities (VENTRICULAR DYSFUNCTION), or a sudden overload beyond its capacity. Chronic heart failure is more common than acute heart failure which results from sudden insult to cardiac function, such as MYOCARDIAL INFARCTION.

Enlargement of the HEART, usually indicated by a cardiothoracic ratio above 0.50. Heart enlargement may involve the right, the left, or both HEART VENTRICLES or HEART ATRIA. Cardiomegaly is a nonspecific symptom seen in patients with chronic systolic heart failure (HEART FAILURE) or several forms of CARDIOMYOPATHIES.

Heart failure caused by abnormal myocardial relaxation during DIASTOLE leading to defective cardiac filling.

Heart failure caused by abnormal myocardial contraction during SYSTOLE leading to defective cardiac emptying.

Agents that have a strengthening effect on the heart or that can increase cardiac output. They may be CARDIAC GLYCOSIDES; SYMPATHOMIMETICS; or other drugs. They are used after MYOCARDIAL INFARCT; CARDIAC SURGICAL PROCEDURES; in SHOCK; or in congestive heart failure (HEART FAILURE).

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