Objective: To explore the occurrence of cognitive impairment in Chinese heart failure (HF) patients and it's impact on prognosis. Methods: In this prospective observational study, a total of 990 HF patients were enrolled from 24 hospitals in China during December 2012 to November 2014. All patients were administrated with the interview-format Montreal Cognitive Assessment (MoCA), according to which they were divided into MoCA<26 (with cognitive impairment) group and MoCA≥26 (without cognitive impairment) group. Baseline data were collected and a 1-year follow up was carried out. Univariate and multivariate logistic or Cox regression were performed for 1-year outcomes. Results: Cognitive impairment was evidenced in 628 patients (63.4%) and they were more likely to be older, female, and with higher proportion of New York Heart Association(NYHA) class Ⅲ-Ⅳ, chronic obstructive pulmonary disease (COPD), ischemic heart disease, while body mass index (BMI), education level, and medical insurance rate were lower (all P<0.05) as compared to patients in MoCA≥26 group. The rate of percutaneous intervention, device implantation, cardiac surgery and evidence-based medications were significantly lower in MoCA<26 group than in MoCA≥26 group (all P<0.05). During the 1-year follow up, patients in the MoCA<26 group had higher all-cause mortality (10.2%(64/628) vs. 2.2%(8/362), P<0.01), cardiovascular mortality (5.9%(37/628) vs. 0.8%(3/362), P<0.01) and major adverse cardiac and cerebrovascular events (MACCE) (9.6%(60/628) vs. 2.5%(8/362), P<0.01) than patients in the MoCA≥26 group. In univariate regression, MoCA<26 was associated with increased all-cause mortality (HR(95%CI):4.739(2.272-9.885), P<0.01), cardiovascular mortality (HR(95%CI):7.258(2.237-23.548), P=0.001) and MACCE (OR(95%CI):4.143(2.031-8.453), P<0.01). After adjustment by multivariate regression, MoCA<26 was indicated as an independent risk factor for all-cause mortality (HR(95%CI): 6.387(2.533-16.104), P<0.01), cardiovascular mortality (HR(95%CI): 10.848(2.586-45.506), P=0.001) and MACCE (OR(95%CI): 4.081(1.299-12.816), P=0.016), while not for re-hospitalization for HF (OR(95%CI):1.010(0.700-1.457), P=0.957). Conclusions: Cognitive impairment is common in HF patients,and it is an independent prognostic factor for 1-year outcomes. Routine cognitive function assessment and active intervention are thus recommended for HF patients.
目的： 探讨中国心力衰竭（心衰）患者认知功能减低的发病情况及其对预后的影响。 方法： 该研究为前瞻性观察性研究。2012年12月至2014年11月从中国24家医院连续入选心衰患者990例，所有患者均进行蒙特利尔认知评分（MoCA），以评估患者的认知功能，按得分将患者分为MoCA<26分组（存在认知功能减低）和MoCA≥26分组（不存在认知功能减低）。记录入选患者的基线资料，并随访1年。主要终点包括1年全因死亡，次要终点包括1年心血管死亡、主要不良心脑血管事件（MACCE）、因心衰住院。采用单因素和多因素Cox回归分析评估心衰患者1年全因死亡、心血管死亡的危险因素，采用单因素和多因素logistic回归分析评估MACCE、因心衰住院的危险因素。 结果： 990例心衰患者中MoCA评分<26分者628例，占63.4%（MoCA<26分组），MoCA≥26分者362例（MoCA≥26分组）。与MoCA≥26分组比较，MoCA<26分组患者年龄较大（P<0.01），女性、纽约心脏协会（NYHA）心功能Ⅲ~Ⅳ级、慢性阻塞性肺疾病、缺血性心脏病者比例较高（P均<0.05），体重指数（BMI）、教育程度和医疗保险率较低（P均<0.01），行介入治疗、器械置入和心脏外科手术史者比例较低（P均<0.05），β受体阻滞剂、血管紧张素转换酶抑制剂（ACEI）/血管紧张Ⅱ素受体阻滞剂（ARB）使用率较低（P均<0.05）。MoCA<26分组患者1年全因死亡、心血管死亡和MACCE发生率均明显高于MoCA≥26分组[分别为10.2%（64/628）比2.2%（8/362）、5.9%（37/628）比0.8%（3/362）和9.6%（60/628）比2.5%（8/362），P均<0.001]，因心衰住院率两组间差异无统计学意义[19.7%（124/628）比16.6%（60/362），P=0.217]。单因素Cox回归分析结果显示，MoCA<26分是心衰患者1年全因死亡（HR=4.739，95%CI 2.272~9.885, P<0.01）、心血管死亡（HR=7.258，95%CI 2.237~23.548, P=0.001）的危险因素。单因素logistic回归分析结果显示MoCA<26分是心衰患者1年MACCE发生的危险因素（OR=4.143，95%CI 2.031~8.453, P<0.01）。在校正了其他危险因素（NYHA心功能分级、血压、颈静脉压、糖尿病、慢性肾功能不全、既往心肌梗死史、卒中、N末端B型利钠肽原水平等）后，多因素Cox回归分析结果显示MoCA<26分是心衰患者1年全因死亡（HR=6.387，95%CI 2.533~16.104，P<0.01）和心血管死亡（HR=10.848，95%CI 2.586~45.506, P=0.001）的独立危险因素。多因素logistic回归分析结果显示MoCA<26分是心衰患者1年MACCE的独立危险因素（OR=4.081，95%CI 1.299~12.816，P=0.016），但不是因心衰住院的独立危险因素（OR=1.010，95%CI 0.700~1.457，P=0.957）。 结论： 中国心衰患者认知功能减低的发生率较高，心衰患者认知功能减低是1年全因死亡、心血管死亡和MACCE的独立危险因素。.
Keywords: Cognition disorders; Heart failure; Montreal Cognitive Assessment; Prognosis.