ABSTRACT
BACKGROUND: Although mild cognitive impairment (MCI) has received much attention as a precursor of dementia, its prognostic role has not been fully clarified in patients with heart failure (HF). METHODS AND RESULTS: We studied 274 patients admitted for acute decompensated HF. Cognitive function was evaluated using Mini Mental State Examination (MMSE). According to the previous definition, MMSE of 0-23, 24-27, and 28-30 were classified as CI (nâ¯=â¯132), MCI (nâ¯=â¯81), and normal cognitive function (nâ¯=â¯61). The primary endpoint was cardiac events, defined as the composite of unplanned HF hospitalization and cardiovascular mortality. During a mean follow-up period of 4.9⯱â¯3.1â¯years, 145 patients experienced cardiac events. Multivariable logistic regression analysis showed that hypertension (pâ¯=â¯0.043), low cardiac index (pâ¯=â¯0.022), and low serum albumin level (pâ¯=â¯0.041) had a significant association with cognitive abnormalities. Both CI and MCI were significantly associated with cardiac events after Cox multivariable adjustment [CI: pâ¯=â¯0.001, adjusted HR 2.66 (1.48-4.77); MCI: pâ¯=â¯0.025, adjusted HR 1.90 (1.09-3.31), normal cognitive function group: reference]. Patients with MCI had a significantly higher risk of unplanned HF hospitalization [pâ¯=â¯0.033, adjusted HR 1.91 (1.05-3.47)], but not all-cause mortality (pâ¯=â¯0.533) or cardiovascular mortality (pâ¯=â¯0.920), while CI was significantly associated with all-cause mortality (pâ¯=â¯0.025) and cardiovascular mortality (pâ¯=â¯0.036). CONCLUSION: Even MCI had a significant risk of cardiac events in patients with acute decompensated HF. This risk was mainly derived from unplanned HF hospitalization.