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Am Fam Physician. 2004;69(3):721-722

One of the major reasons for hospital admission in patients older than 65 years is exacerbation of heart failure. Over the past few years, hospital admissions for patients 85 years or older increased by 25 percent. Over the next few years, the prevalence of heart failure is expected to double as the population ages. In addition, older patients hospitalized with heart failure have a one-month mortality rate of 25 percent, with a one-year mortality rate of more than 50 percent. Several studies have reported a higher prevalence of cognitive dysfunction in patients with heart failure. In addition, cognitive dysfunction is an independent risk predictor of disability in patients with heart failure. Zuccalà and colleagues evaluated the prognostic value of cognitive impairment in older patients hospitalized for heart failure.

Patients enrolled in the study were from 81 different health centers and were admitted with the primary diagnosis of heart failure. Cognitive performance was assessed using a standardized mental test and a cutoff set that yielded 100 percent sensitivity and 71 percent specificity. The one-year in-hospital and out-of-hospital mortality rates also were assessed for the study population.

A total of 968 patients were included in the study, with an average age of 76 years. The inhospital and out-of-hospital mortality rates were significantly higher in patients with cognitive impairment than in patients with normal cognitive function. After adjusting for several variables, cognitive impairment was associated with approximately a five-fold increase in the risk of in-hospital mortality compared with normal cognition. Patients with cognitive impairment also had a decreased one-year survival rate.

The authors conclude that cognitive impairment is an independent prognostic marker in older patients with heart failure. They add that even simple screening tests for cognitive function should be a part of the routine evaluation of these patients.

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