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We assessed the prevalence of cognitive/memory problems in veteran patients with heart failure, and evaluated its relationship to medication compliance.
Heart failure (HF) is a costly, chronic, and complex condition that impacts veterans' quality of life, morbidity, and mortality. In the VA population up to 20% of patients are readmitted for HF within 30 days. Non-adherence to prescribed medication and self-care regimens in patients with HF is known to lead to increased morbidity, including readmissions. Cognitive impairment (CI) has been shown to predict nonadherence in elderly people without HF, however, this link has not been studied in HF populations. In the non-veteran population, HF patients are known to have an increased prevalence of cognitive impairment (CI), however, no existing study has determined the extent and type of CI in veterans with HF.
This pilot study was designed as a descriptive cross-sectional study as a pre-implementation effort with following goals: (1) determine the prevalence of CI in veterans with all-cause HF in an outpatient setting; (2) quantitatively describe the extent of CI in this population; (3) qualitatively describe neuropsychological domains affected by CI; (4) evaluate the association of CI with medication adherence and other clinical variables.
All consenting eligible outpatients in our VA HF clinic underwent a simple screening test for CI (Saint Louis University Mental Status Exam). Demographic and clinical variables were collected by patient interviews and chartg reviews, and included Geriatric Depression Scale and questionnaires about medication-taking behaviors. All subjects were invited back for 30-day direct pill count of all their routinely prescribed medications. Subjects who screened positive for CI were invited back for a modified battery of neuropsychological tests to determine the cognitive domains affected. Subjects will also be followed after the 12-month study period to collect data on hospital readmissions.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Heart Failure | veteran population with documented heart failure |
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| Measure | Description | Time Frame |
|---|---|---|
| SLUMS Scores | SLUMS (Saint Louis University Mental Status) exam is a validated screening test for cognitive impairment (CI) consisting of 30-point interview scale. SLUMS is considered positive for mild CI if the score is <27 in a person with a high school diploma or <25 in a person who did not complete high school. SLUMS screening is considered positive for severe impairment consistent with dementia if the score is <21 for persons with a high school diploma and <20 for persons who did not complete high school. | baseline collection |
| Measure | Description | Time Frame |
|---|---|---|
| Medication Adherence | To capture both overtaking and undertaking medication, a "delta" was determined for each medication by computing the absolute difference between the number of pills taken and the number prescribed over the 30-day period. The delta values for each medication were summed for each individual subject, divided by the total number of pills prescribed, subtracted from 1, and finally multiplied by 100 to obtain an adherence score expressed as a percentage. |
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Inclusion Criteria:
Exclusion Criteria:
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veteran patients enrolled in outpatient heart failure clinic
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| Name | Affiliation | Role |
|---|---|---|
| Helme Silvet, MD | VA Loma Linda Healthcare System, Loma Linda, CA | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| VA Loma Linda Healthcare System, Loma Linda, CA | Loma Linda | California | 92357 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 22784869 | Result | Hawkins LA, Kilian S, Firek A, Kashner TM, Firek CJ, Silvet H. Cognitive impairment and medication adherence in outpatients with heart failure. Heart Lung. 2012 Nov-Dec;41(6):572-82. doi: 10.1016/j.hrtlng.2012.06.001. Epub 2012 Jul 10. |
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| ID | Title | Description |
|---|---|---|
| FG000 | Heart Failure | veteran population with documented heart failure |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Evaluation of Cognitive Impairment |
| |||||||||||||
| Pill Counts |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Group 1 | veteran population with documented heart failure |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | SLUMS Scores | SLUMS (Saint Louis University Mental Status) exam is a validated screening test for cognitive impairment (CI) consisting of 30-point interview scale. SLUMS is considered positive for mild CI if the score is <27 in a person with a high school diploma or <25 in a person who did not complete high school. SLUMS screening is considered positive for severe impairment consistent with dementia if the score is <21 for persons with a high school diploma and <20 for persons who did not complete high school. | Posted | Mean | Standard Deviation | scores on a scale | baseline collection |
|
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Group 1 | veteran population with documented heart failure |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr Helme Silvet | VA Loma Linda Healthcare System | 9095836097 | helme.silvet@va.gov |
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| ID | Term |
|---|---|
| D006333 | Heart Failure |
| D003072 | Cognition Disorders |
| D060825 | Cognitive Dysfunction |
| D055118 | Medication Adherence |
| ID | Term |
|---|---|
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D019965 | Neurocognitive Disorders |
| D001523 | Mental Disorders |
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| 30 days |
|
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| Living arrangement | Number | participants |
|
| education | Number | participants |
|
| self-perceived financial status | Number | participants |
|
| Diabetes (I or II) | Number | participants |
|
| Coronary Artery Disease | Number | participants |
|
| Hypertension | Number | participants |
|
| Obstructive sleep apnea | Number | participants |
|
| History of atrial fibrillation | Number | participants |
|
| History of stroke | Number | participants |
|
| Systolic blood pressure | Mean | Standard Deviation | mm hG |
|
| Thiamine level | Mean | Standard Deviation | nmol/L |
|
| Vitamin B12 level | Mean | Standard Deviation | pg/mL |
|
| Hemoglobin level | Mean | Standard Deviation | g/dL |
|
| Serum creatinine level | Mean | Standard Deviation | mg/dL |
|
| Thyroid-stimulating hormone | Mean | Standard Deviation | uiU/mL |
|
| Brain natriuretic peptide level | Mean | Standard Deviation | pg/mL |
|
| Hemoglobin A1c | Mean | Standard Deviation | % |
|
| Heart Failure duration | Number | participants |
|
| Heart failure cause | Number | participants |
|
| Left ventricular ejection fraction | Number | participants |
|
| Left ventricular ejection fraction | Mean | Standard Deviation | % |
|
| History of depression | Number | participants |
|
| Geriatric Depression Scale | Geriatric Depression Scale (GDS) is a validated self-report measure consisting of 30 questions used to screen elderly people for depression. Cutoff scores are as follows: 0-9 normal, 10-19 mildly depressed, 20-30 severely depressed. | Mean | Standard Deviation | scores on a scale |
|
| History of PTSD | Number | participants |
|
| Tobacco use | Number | participants |
|
| Alcohol use | Number | participants |
|
| Marijuana use | Number | participants |
|
| Other illicit substance use | Number | participants |
|
| Received treatment in heart failure specialty clinic | Number | participants |
|
| Prescribing providers | Mean | Standard Deviation | prescribing providers |
|
| Hospitalizations in past year | Mean | Standard Deviation | hospitalizations |
|
| Participants |
|
|
|
| Secondary | Medication Adherence | To capture both overtaking and undertaking medication, a "delta" was determined for each medication by computing the absolute difference between the number of pills taken and the number prescribed over the 30-day period. The delta values for each medication were summed for each individual subject, divided by the total number of pills prescribed, subtracted from 1, and finally multiplied by 100 to obtain an adherence score expressed as a percentage. | Posted | Mean | 95% Confidence Interval | percentage of adherence | 30 days |
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| 0 |
| 251 |
| 0 |
| 251 |
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| D010349 |
| Patient Compliance |
| D010342 | Patient Acceptance of Health Care |
| D000074822 | Treatment Adherence and Compliance |
| D015438 | Health Behavior |
| D001519 | Behavior |