Incidence, Clinical Correlates, and Prognostic Impact of Dementia in Heart Failure: A Population-Based Cohort Study

• Published in: JACC. Asia 2023-02, Vol.3 (1), p.108-119
• Main Authors: Ren, Qing-Wen, Katherine Teng, Tiew-Hwa, Tse, Yi-Kei, Tay, Wan Ting, Li, Hang-Long, Tromp, Jasper, Yu, Si-Yeung, Hung, Denise, Wu, Mei-Zhen, Chen, Christopher, Yuk Yuen, Jacqueline Kwan, Huang, Jia-Yi, Ouwerkerk, Wouter, Li, Xin-Li, Teramoto, Kanako, Chandramouli, Chanchal, Tse, Hung-Fat, Lam, Carolyn S P, Yiu, Kai-Hang
• Format: Article
• Language: English
• Subjects: Original Research
• ISSN: 2772-3747
• DOI: 10.1016/j.jacasi.2022.09.016

Heart failure (HF) may increase the risk of dementia via shared risk factors. The authors investigated the incidence, types, clinical correlates, and prognostic impact of dementia in a population-based cohort of patients with index HF. The previously territory-wide database was interrogated to identify eligible patients with HF (N = 202,121) from 1995 to 2018. Clinical correlates of incident dementia and their associations with all-cause mortality were assessed using multivariable Cox/competing risk regression models where appropriate. Among a total cohort aged ≥18 years with HF (mean age 75.3 ± 13.0 years, 51.3% women, median follow-up 4.1 [IQR: 1.2-10.2] years), new-onset dementia occurred in 22,145 (11.0%), with age-standardized incidence rate of 1,297 (95% CI: 1,276-1,318) per 10,000 in women and 744 (723-765) per 10,000 in men. Types of dementia were Alzheimer's disease (26.8%), vascular dementia (18.1%), and unspecified dementia (55.1%). Independent predictors of dementia included: older age (≥75 years, subdistribution hazard ratio [SHR]: 2.22), female sex (SHR: 1.31), Parkinson's disease (SHR: 1.28), peripheral vascular disease (SHR: 1.46), stroke (SHR: 1.24), anemia (SHR: 1.11), and hypertension (SHR: 1.21). The population attributable risk was highest for age ≥75 years (17.4%) and female sex (10.2%). New-onset dementia was independently associated with increased risk of all-cause mortality (adjusted SHR: 4.51;  < 0.001). New-onset dementia affected more than 1 in 10 patients with index HF over the follow-up, and portended a worse prognosis in these patients. Older women were at highest risk and should be targeted for screening and preventive strategies.