Heart Failure Clinical Trial
Official title:
Cognitive Impairment as a Risk for the Admission-Readmission Cycle Seen in Veterans With Heart Failure: Closing the Adherence Gap
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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Observational Model: Cohort, Time Perspective: Prospective
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