Cognitive function and adherence to treatment in patients with chronic heart failure and reduced left ventricular ejection fraction: relation and prognostic meaning
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Abstract
The aim – to investigate the relationship between cognitive function and adherence to treatment; to evaluate the predictive value of adherence to treatment questionnaires in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (LVEF).
Material and methods. 124 pts with stable CHF and reduced (< 40 %) LVEF NYHA II–IV not older than 75 years were examined. Besides routine clinical examination, standard neuropsychological tests (Mini Mental State Examination – MMSE, Schulte test, the HADS scale) were used. To assess adherence to the treatment, the Moriski – Green questionnaire and the disease-specific questionnaire of heart failure department were used. Cognitive dysfunction was defined as MMSE ≤ 26 points.
Results. After distribution of pts to three groups depending on their adherence to treatment, it was found that they significantly differed in MMSE and Shulte test results. The number of points regarding adherence to treatment
(Moriski – Green questionnaire and the questionnaire of heart failure department) directly correlated with MMSE (P=0.038 and P=0.023, respectively). The group of patients with high compliance had significantly better cognitive tests results (MMSE and Schultze) than the group of patients with moderate/low compliance – this was equally relevant to both questionnaires. The construction of survival curves showed that Moriski – Green questionnaire had no reliable prognostic significance both in relation to death and combined critical event (mortality/hospitalization) (P=0.113 and P=0.401, respectively); At the same time, the disease-specific questionnaire of heart failure department showed value regarding the prediction of long-term survival and the onset of a combined critical event (P=0.046 and P=0.024, respectively).
Conclusion: More than half of pts with CHF and reduced LVEF have low and moderate adherence to treatment, which is associated with worse cognitive tests results (MMSE and Schulte). Evidence of relationship between adherence to treatment and cognitive function evaluated using our questionnaire were comparable to those obtained by Moriski – Green questionnaire. Using disease-specific questionnaire of heart failure department had a high value in predicting long-term survival and the onset of combined critical event (death or hospitalization) in patients with CHF and reduced LVEF, while the Moriski – Green questionnaire did not demonstrate the above-mentioned predictive value.
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