Reduced cognitive function is associated with poor outcomes in HFpEF: a post hoc analysis from PARAGON-HF

Abstract

Abstract Background Little is known about the prevalence and consequences of cognitive impairment in patients with heart failure and preserved ejection fraction (HFpEF). Purpose To describe the prevalence of cognitive impairment in HFpEF and the association between cognitive function and outcomes in patients with HFpEF. Methods In the Prospective Comparison of ARNI With ARB Global Outcomes in Heart Failure With Preserved Ejection Fraction trial (PARAGON-HF), cognitive function was tested in a subgroup of patients at baseline and during follow-up, using the Mini-Mental State Examination [MMSE] which has a maximum score of 30, with a higher score reflecting better cognitive function. Patients were divided into 3 groups according to baseline score: ≤24 representing cognitive impairment, 25–27 reflecting borderline cognitive impairment and ≥28 normal cognition. The primary endpoint used in this analysis was a composite of first heart failure hospitalization (HFH) or cardiovascular death (CVD). We examined the relationship between baseline MMSE score and this outcome, its components and all-cause mortality. We adjusted for other standard prognostic variables, including NT-proBNP (see Table footnote). Results Among the 2895 patients (60% of total) in PARAGON-HF with a baseline MMSE measurement, 415 (14.3%) had a score ≤24, 671 (23.2%) a score 25–27 and 1809 (62.5%) a score ≥28. Over a median follow-up of 35 (IQR 30–41) months, the unadjusted and adjusted risks of the primary composite (Table), its components and all-cause death (Figure) were higher in patients with lower baseline MMSE scores. Conclusions Even mild cognitive impairment, as measured by the MMSE, is predictive of adverse outcomes in HFpEF Funding Acknowledgement Type of funding source: Private company. Main funding source(s): PARAGON-HF was funded by Novartis Pharma