Sustaining Quality of Life of the Aged: Transplant or Mechanical Support: Baseline Cognitive Dysfunction

Abstract

Introduction Cognitive dysfunction (CD), a risk factor for poor outcomes, is common in older patients (pts) with advanced heart failure (HF). Given these pts may be candidates for heart transplantation (HT) or mechanical circulatory support as destination therapy (DT MCS), we compared CD in older advanced HF pts prior to HT and DT MCS. Methods A total of 263 advanced HF pts from 11 U.S. sites either listed for HT (n=164; 75 HT-MCS and 89 HT-non-MCS) or scheduled for DT MCS (n=99) were enrolled between 10/1/15-1/1/18 and completed the Montreal Cognitive Assessment (MoCA), a 10-minute screening instrument (worst-to-best total score range=0-30), including 7 cognitive domains, to detect CD (MoCA total score less than 26). Risk-unadjusted statistical analyses included descriptive statistics, ANOVA, and chi-square tests. To risk-adjust for baseline age differences, we used linear regression and polytomous logistic regression models. Results The majority of advanced HF pts were white males. DT MCS candidates were older than HT candidates and had more co-morbidities (DT = 4.6±2.1 vs HT-MCS = 3.9±2.0 vs HT-non-MCS =3.7±1.7, p=0.008). More DT MCS candidates had CD than HT candidates. DT MCS candidates had lower total MoCA scores and lower scores in all domains except naming, abstraction and orientation (strong trend), compared with HT-MCS and HT-non-MCS candidates. See table. The same conclusions were reached after baseline age-adjustment. See table. Conclusions CD exists in older pts with advanced HF who are candidates for DT MCS and HT. DT MCS pts may be at highest risk. Baseline CD in these pts may inform shared decision making discussions about remaining on medical therapy vs choosing these surgical treatment options.