Abstract 15098: Heart Failure and Cognitive Impairment in The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Of five million Americans with heart failure (HF), approximately half are estimated to have cognitive impairment. HF has been proposed as an independent risk factor for cognitive impairment. Hypothesis: We hypothesized that persons with HF would have worse cognition and greater decline in cognition over time, as compared to those without HF. Methods: The Atherosclerosis Risk in Communities (ARIC) study, a biracial cohort composed of participants from four U.S. communities, classified prevalent HF and cognition (normal, mild cognitive impairment [MCI] or dementia) in 6431 participants at a 5th follow-up visit (2011-2013). HF was further categorized as preserved ejection fraction ≥50% (HFpEF) or reduced (HFrEF). Controlling for confounders, multinomial logit was used to estimate the association between cognition and prevalent HF (n=941: 658 HFpEF; 103 HFrEF; 180 missing EF). Separately, using data for 5415 participants without HF at Visit 4 (1996-1998), linear regression was used to estimate the association between a standardized measure of change in cognition from Visit 4 to 5 and prevalent HF at Visit 5. Both analyses used inverse probability weighting to adjust for non-participation at Visit 5 and multiple imputation for missing covariate information. Results: Compared to those without HF, at mean age 75 years, individuals with prevalent HF were at increased risk of dementia (Relative Risk Ratio= 1.8 [95% CI: 1.3, 2.6]) and MCI (RRR=1.4 [1.1, 1.7]). The decline in cognition occurring over 15 years between Visits 4 and 5 was significantly greater among persons who developed HF (mean standardized z score of -0.11 at Visit 4 to -1.00 at Visit 5) compared to those who did not (mean score of 0.28 at Visit 4 to -0.48 at Visit 5), representing an adjusted difference of -0.07, [-0.14, -0.01]. Estimated associations in both analyses were slightly larger for HFrEF versus HFpEF but differences were not statistically significant due to limited sample for HFrEF. Conclusion: HF is associated with increased risk of dementia and MCI. Potential differences in cognitive status among those with HFrEF versus HFpEF warrant further investigation.