Alzheimer's Disease and Related Dementias and Heart Failure

A Community Study

Sheila M. Manemann MPH; David S. Knopman MD; Jennifer St. Sauver PhD; Suzette J. Bielinski PhD; Alanna M. Chamberlain PhD; Susan A. Weston MS; Ruoxiang Jiang BS; Véronique L. Roger MD, MPH

Disclosures

J Am Geriatr Soc. 2022;70(6):1664-1672. 

In This Article

Abstract and Introduction

Abstract

Background: Cognitive function is essential to effective self-management of heart failure (HF). Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) can coexist with HF, but its exact prevalence and impact on health care utilization and death are not well defined.

Methods: Residents from 7 southeast Minnesota counties with a first-ever diagnosis code for HF between January 1, 2013 and December 31, 2018 were identified. Clinically diagnosed AD/ADRD was ascertained using the Centers for Medicare and Medicaid (CMS) Chronic Conditions Data Warehouse algorithm. Patients were followed through March 31, 2020. Cox and Andersen-Gill models were used to examine associations between AD/ADRD (before and after HF) and death and hospitalizations, respectively.

Results: Among 6336 patients with HF (mean age [SD] 75 years [14], 48% female), 644 (10%) carried a diagnosis of AD/ADRD at index HF diagnosis. The 3-year cumulative incidence of AD/ADRD after HF diagnosis was 17%. During follow-up (mean [SD] 3.2 [1.9] years), 2618 deaths and 15,475 hospitalizations occurred. After adjustment, patients with AD/ADRD before HF had nearly a 2.7 times increased risk of death, but no increased risk of hospitalization compared to those without AD/ADRD. When AD/ADRD was diagnosed after the index HF date, patients experienced a 3.7 times increased risk of death and a 73% increased risk of hospitalization compared to those who remain free of AD/ADRD.

Conclusions: In a large, community cohort of patients with incident HF, the burden of AD/ADRD is quite high as more than one-fourth of patients with HF received a diagnosis of AD/ADRD either before or after HF diagnosis. AD/ADRD markedly increases the risk of adverse outcomes in HF underscoring the need for future studies focused on holistic approaches to improve outcomes.

Introduction

Heart failure (HF) is a disease of aging populations that occurs in the context of multimorbidity. Nearly 86% of patients with HF have 2 or more additional chronic conditions.[1] Thus, addressing the HF epidemic requires an understanding of multimorbidity in HF populations and, in particular, how coexisting conditions interact with HF to impact clinical outcomes and health care utilization.

Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) occupy a distinct position within the spectrum of conditions that coexist with HF.[2] Indeed, an excess risk of cognitive impairment among persons with HF was recently reported in the Atherosclerosis Risk in Communities (ARIC) study independently of other comorbid conditions.[3] However, the prevalence of overt clinical AD/ADRD in HF and its impact on health care utilization and outcomes remains to be fully delineated. AD/ADRD can adversely impact the management of HF given that HF requires effective self-management that in turn relies on cognitive function. Defining the association between AD/ADRD and adverse outcomes in HF is an important first step in designing optimal care plans. Thus, we undertook this study to investigate the occurrence of AD/ADRD and its impact on adverse outcomes, including death and hospitalizations, among patients with HF.

processing....