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

Qing-Wen Ren; Tiew-Hwa Katherine Teng; Yi-Kei Tse; Wan Ting Tay; Hang-Long Li; Jasper Tromp; Si-Yeung Yu; Denise Hung; Mei-Zhen Wu; Christopher Chen; Jacqueline Kwan Yuk Yuen; Jia-Yi Huang; Wouter Ouwerkerk; Xin-Li Li; Kanako Teramoto; Chanchal Chandramouli; Hung-Fat Tse; Carolyn S P Lam; Kai-Hang Yiu

doi:10.1016/j.jacasi.2022.09.016

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

JACC Asia. 2023 Jan 3;3(1):108-119. doi: 10.1016/j.jacasi.2022.09.016. eCollection 2023 Feb.

Authors

Qing-Wen Ren^{1

2}, Tiew-Hwa Katherine Teng^{3

4

5}, Yi-Kei Tse², Wan Ting Tay³, Hang-Long Li², Jasper Tromp^{3

6

7}, Si-Yeung Yu², Denise Hung², Mei-Zhen Wu^{1

2}, Christopher Chen⁸, Jacqueline Kwan Yuk Yuen⁹, Jia-Yi Huang^{1

2}, Wouter Ouwerkerk^{3

10}, Xin-Li Li¹¹, Kanako Teramoto³, Chanchal Chandramouli^{3

4}, Hung-Fat Tse^{1

2}, Carolyn S P Lam^{3

4

7}, Kai-Hang Yiu^{1

2}

Affiliations

¹ Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.
² Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
³ National Heart Centre Singapore, Singapore.
⁴ Duke-NUS Medical School, Singapore.
⁵ School of Allied Health, University of Western Australia, Perth, Australia.
⁶ Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
⁷ University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands.
⁸ Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁹ Division of Geriatrics, Department of Medicine, The University of Hong Kong, Hong Kong, China.
¹⁰ Department of Dermatology, University of Amsterdam Medical Centre, Amsterdam, the Netherlands.
¹¹ Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.

Abstract

Background: Heart failure (HF) may increase the risk of dementia via shared risk factors.

Objectives: The authors investigated the incidence, types, clinical correlates, and prognostic impact of dementia in a population-based cohort of patients with index HF.

Methods: 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.

Results: 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; P < 0.001).

Conclusions: 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.

Keywords: AD, Alzheimer’s disease; CDARS, Clinical Data Analysis and Reporting System; CVD, cardiovascular death; HF, heart failure; ICD, International Classification of Diseases; PAF, population attributable fractions; SHR, subdistribution hazard ratio; VD, vascular dementia; clinical correlates; dementia; heart failure; mortality; sex differ.