Incidence and predictors of cognitive decline in patients with left ventricular assist devices

Timothy J. Fendler, John A. Spertus, Kensey L. Gosch, Philip G. Jones, Jared M. Bruce, Michael E. Nassif, Kelsey M. Flint, Shannon M Dunlay, Larry A. Allen, Suzanne V. Arnold

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background - After left ventricular assist device (LVAD) placement for advanced heart failure, increased cerebral perfusion should result in improved cognitive function. However, stroke (a well-known LVAD complication) and subclinical cerebral ischemia may result in transient or permanent cognitive decline. We sought to describe the incidence and predictors of cognitive decline after LVAD using a valid, sensitive assessment tool. Methods and Results - Among 4419 patients in the Interagency Registry for Mechanically Assisted Circulatory Support who underwent LVAD implantation between May 2012 and December 2013, cognitive function was assessed in 1173 patients with the Trail Making B Test before LVAD and at 3, 6, and 12 months. The test detects several forms of cognitive impairment, including subclinical stroke. Cognitive decline was defined as a clinically important increase during follow-up using a moderate Cohen d effect size of 0.5×baseline SD (32 s). The cumulative incidence of cognitive decline in the year after LVAD implantation, treating death and transplantation as competing risks, was 29.2%. In adjusted analysis, older age (≥70 versus <50 years; hazard ratio, 2.24; 95% confidence interval 1.46-3.44; P trend <0.001) and destination therapy (hazard ratio, 1.42; 95% confidence interval, 1.05-1.92) were significantly associated with greater risk of cognitive decline. Conclusions - Cognitive decline occurs commonly in patients in the year after LVAD and is associated with older age and destination therapy. These results could have important implications for patient selection and improved communication of risks before LVAD implantation. Additional studies are needed to explore the association between cognitive decline and subsequent stroke, health status, and mortality in patients after LVAD.

Original languageEnglish (US)
Pages (from-to)285-291
Number of pages7
JournalCirculation: Cardiovascular Quality and Outcomes
Volume8
Issue number3
DOIs
StatePublished - May 26 2015

Fingerprint

Heart-Assist Devices
Incidence
Stroke
Cognition
Confidence Intervals
Trail Making Test
Cognitive Dysfunction
Brain Ischemia
Patient Selection
Health Status
Registries
Heart Failure
Perfusion
Transplantation
Communication
Mortality

Keywords

  • brain ischemia
  • heart-assist devices
  • mild cognitive impairment

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Fendler, T. J., Spertus, J. A., Gosch, K. L., Jones, P. G., Bruce, J. M., Nassif, M. E., ... Arnold, S. V. (2015). Incidence and predictors of cognitive decline in patients with left ventricular assist devices. Circulation: Cardiovascular Quality and Outcomes, 8(3), 285-291. https://doi.org/10.1161/CIRCOUTCOMES.115.001856

Incidence and predictors of cognitive decline in patients with left ventricular assist devices. / Fendler, Timothy J.; Spertus, John A.; Gosch, Kensey L.; Jones, Philip G.; Bruce, Jared M.; Nassif, Michael E.; Flint, Kelsey M.; Dunlay, Shannon M; Allen, Larry A.; Arnold, Suzanne V.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 8, No. 3, 26.05.2015, p. 285-291.

Research output: Contribution to journalArticle

Fendler, TJ, Spertus, JA, Gosch, KL, Jones, PG, Bruce, JM, Nassif, ME, Flint, KM, Dunlay, SM, Allen, LA & Arnold, SV 2015, 'Incidence and predictors of cognitive decline in patients with left ventricular assist devices', Circulation: Cardiovascular Quality and Outcomes, vol. 8, no. 3, pp. 285-291. https://doi.org/10.1161/CIRCOUTCOMES.115.001856
Fendler, Timothy J. ; Spertus, John A. ; Gosch, Kensey L. ; Jones, Philip G. ; Bruce, Jared M. ; Nassif, Michael E. ; Flint, Kelsey M. ; Dunlay, Shannon M ; Allen, Larry A. ; Arnold, Suzanne V. / Incidence and predictors of cognitive decline in patients with left ventricular assist devices. In: Circulation: Cardiovascular Quality and Outcomes. 2015 ; Vol. 8, No. 3. pp. 285-291.
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abstract = "Background - After left ventricular assist device (LVAD) placement for advanced heart failure, increased cerebral perfusion should result in improved cognitive function. However, stroke (a well-known LVAD complication) and subclinical cerebral ischemia may result in transient or permanent cognitive decline. We sought to describe the incidence and predictors of cognitive decline after LVAD using a valid, sensitive assessment tool. Methods and Results - Among 4419 patients in the Interagency Registry for Mechanically Assisted Circulatory Support who underwent LVAD implantation between May 2012 and December 2013, cognitive function was assessed in 1173 patients with the Trail Making B Test before LVAD and at 3, 6, and 12 months. The test detects several forms of cognitive impairment, including subclinical stroke. Cognitive decline was defined as a clinically important increase during follow-up using a moderate Cohen d effect size of 0.5×baseline SD (32 s). The cumulative incidence of cognitive decline in the year after LVAD implantation, treating death and transplantation as competing risks, was 29.2{\%}. In adjusted analysis, older age (≥70 versus <50 years; hazard ratio, 2.24; 95{\%} confidence interval 1.46-3.44; P trend <0.001) and destination therapy (hazard ratio, 1.42; 95{\%} confidence interval, 1.05-1.92) were significantly associated with greater risk of cognitive decline. Conclusions - Cognitive decline occurs commonly in patients in the year after LVAD and is associated with older age and destination therapy. These results could have important implications for patient selection and improved communication of risks before LVAD implantation. Additional studies are needed to explore the association between cognitive decline and subsequent stroke, health status, and mortality in patients after LVAD.",
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AU - Bruce, Jared M.

AU - Nassif, Michael E.

AU - Flint, Kelsey M.

AU - Dunlay, Shannon M

AU - Allen, Larry A.

AU - Arnold, Suzanne V.

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N2 - Background - After left ventricular assist device (LVAD) placement for advanced heart failure, increased cerebral perfusion should result in improved cognitive function. However, stroke (a well-known LVAD complication) and subclinical cerebral ischemia may result in transient or permanent cognitive decline. We sought to describe the incidence and predictors of cognitive decline after LVAD using a valid, sensitive assessment tool. Methods and Results - Among 4419 patients in the Interagency Registry for Mechanically Assisted Circulatory Support who underwent LVAD implantation between May 2012 and December 2013, cognitive function was assessed in 1173 patients with the Trail Making B Test before LVAD and at 3, 6, and 12 months. The test detects several forms of cognitive impairment, including subclinical stroke. Cognitive decline was defined as a clinically important increase during follow-up using a moderate Cohen d effect size of 0.5×baseline SD (32 s). The cumulative incidence of cognitive decline in the year after LVAD implantation, treating death and transplantation as competing risks, was 29.2%. In adjusted analysis, older age (≥70 versus <50 years; hazard ratio, 2.24; 95% confidence interval 1.46-3.44; P trend <0.001) and destination therapy (hazard ratio, 1.42; 95% confidence interval, 1.05-1.92) were significantly associated with greater risk of cognitive decline. Conclusions - Cognitive decline occurs commonly in patients in the year after LVAD and is associated with older age and destination therapy. These results could have important implications for patient selection and improved communication of risks before LVAD implantation. Additional studies are needed to explore the association between cognitive decline and subsequent stroke, health status, and mortality in patients after LVAD.

AB - Background - After left ventricular assist device (LVAD) placement for advanced heart failure, increased cerebral perfusion should result in improved cognitive function. However, stroke (a well-known LVAD complication) and subclinical cerebral ischemia may result in transient or permanent cognitive decline. We sought to describe the incidence and predictors of cognitive decline after LVAD using a valid, sensitive assessment tool. Methods and Results - Among 4419 patients in the Interagency Registry for Mechanically Assisted Circulatory Support who underwent LVAD implantation between May 2012 and December 2013, cognitive function was assessed in 1173 patients with the Trail Making B Test before LVAD and at 3, 6, and 12 months. The test detects several forms of cognitive impairment, including subclinical stroke. Cognitive decline was defined as a clinically important increase during follow-up using a moderate Cohen d effect size of 0.5×baseline SD (32 s). The cumulative incidence of cognitive decline in the year after LVAD implantation, treating death and transplantation as competing risks, was 29.2%. In adjusted analysis, older age (≥70 versus <50 years; hazard ratio, 2.24; 95% confidence interval 1.46-3.44; P trend <0.001) and destination therapy (hazard ratio, 1.42; 95% confidence interval, 1.05-1.92) were significantly associated with greater risk of cognitive decline. Conclusions - Cognitive decline occurs commonly in patients in the year after LVAD and is associated with older age and destination therapy. These results could have important implications for patient selection and improved communication of risks before LVAD implantation. Additional studies are needed to explore the association between cognitive decline and subsequent stroke, health status, and mortality in patients after LVAD.

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