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Diuresis improves cognitive impairment in patients with HF

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SCOTTSDALE, Ariz. – Cognitive impairment in patients with HF may be improved with effective diuresis, according to the results of an oral abstract presented at the 12^th Annual AAHFN Meeting. Such improvement may also result in a reduction in edema that is associated with improvement on motor speed and mental plasticity tests.

“HF has become one of the leading causes of admission and readmission in the Medicare population,” said Tanya Simmons, RN, BSN, CHFN, of the Johns Hopkins Bayview Medical Center, during her presentation. “We explored whether patients with HF exhibited impaired cognitive function to assess whether effective outpatient treatment with IV diuresis would result in measurable improvement in cognitive performance.”

Tanya Simmons

Simmons and colleagues included 109 patients with HF in their initial, pre-diuresis testing; 66 patients completed follow-up testing after diuresis. The Mini-Mental State Examination was used to assess memory, attention and language; a grooved pegboard examined executive functioning and the Trail Making Test B looked at visual attention, task switching, visual search speed, mental flexibility and executive function. C-reactive protein levels were measured during initial and follow-up testing in 18 participants.

The mean age of patients included in post-diuresis testing was 65.5 and 48.48% were female. Moderate to severe peripheral edema was noted in 46.97% of these patients; 16.67% had moderate to severe pulmonary edema.

Study results demonstrated 3.7-fold increased odds of having a lower score on the grooved pegboard dominant and 4.6-fold increased odds of a lower score on the grooved pegboard non-dominant during the initial visit. Patients with HFpEF had decreased odds of lower scores on the Mini-Mental Status Examination compared with those with HFrEF.

Following IV diuresis, the adjusted beta scores improved across all tests (Mini-Mental State Examination, -0.2; grooved pegboard dominant, -18.2; grooved pegboard non-dominant, 4.4; Trail Making Test B, -29.5). A substudy analysis found that a reduction in C-reactive protein was associated with greater improvement on the Mini-Mental State Examination (P = .014).

“This study demonstrates that patients with HF often show impaired cognitive performance.  Data also suggest that effective diuresis resulting in a reduction of pulmonary and peripheral edema may result in improved cognitive function,” Simmons said during her presentation. “Cognitive status might be a consideration for future education and self-care management interventions for CHF patients. Further evaluation to assess the impact of cognitive impairment on readmission and medical adherence is warranted.” - by Julia Ernst, MS

Reference:

Simmons T, et al. Oral Abstracts 2. Presented at: American Association of Heart Failure Nurses Annual Meeting; June 23-25, 2016; Scottsdale, Ariz.

Disclosure: Simmons reports receiving research grant funding from the DANA Foundation.