AD/ADRD diagnosed before incident heart failure was associated with a 2.7-fold increased risk of death, while AD/ADRD diagnosed after heart failure increased mortality risk 3.7-fold.
Cohort (n=6,336)
Yes
Does Alzheimer's disease and related dementias increase the risk of death and hospitalizations in patients with incident heart failure?
Coexisting Alzheimer's disease and related dementias in patients with incident heart failure is common and significantly increases the risk of subsequent death and hospitalization.
Effect estimate: HR 2.7 (death, AD/ADRD before HF)
BACKGROUND: Cognitive function is essential to effective self-management of heart failure (HF). Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) can coexist with HF, but its exact prevalence and impact on health care utilization and death are not well defined. METHODS: Residents from 7 southeast Minnesota counties with a first-ever diagnosis code for HF between January 1, 2013 and December 31, 2018 were identified. Clinically diagnosed AD/ADRD was ascertained using the Centers for Medicare and Medicaid (CMS) Chronic Conditions Data Warehouse algorithm. Patients were followed through March 31, 2020. Cox and Andersen-Gill models were used to examine associations between AD/ADRD (before and after HF) and death and hospitalizations, respectively. RESULTS: Among 6336 patients with HF (mean age SD 75 years 14, 48% female), 644 (10%) carried a diagnosis of AD/ADRD at index HF diagnosis. The 3-year cumulative incidence of AD/ADRD after HF diagnosis was 17%. During follow-up (mean SD 3.2 1.9 years), 2618 deaths and 15,475 hospitalizations occurred. After adjustment, patients with AD/ADRD before HF had nearly a 2.7 times increased risk of death, but no increased risk of hospitalization compared to those without AD/ADRD. When AD/ADRD was diagnosed after the index HF date, patients experienced a 3.7 times increased risk of death and a 73% increased risk of hospitalization compared to those who remain free of AD/ADRD. CONCLUSIONS: In a large, community cohort of patients with incident HF, the burden of AD/ADRD is quite high as more than one-fourth of patients with HF received a diagnosis of AD/ADRD either before or after HF diagnosis. AD/ADRD markedly increases the risk of adverse outcomes in HF underscoring the need for future studies focused on holistic approaches to improve outcomes.
Manemann et al. (Fri,) conducted a cohort in Heart failure and Alzheimer's disease/related dementias (n=6,336). Alzheimer's disease and related dementias (AD/ADRD) vs. Patients without AD/ADRD was evaluated on Death and hospitalizations (HR 2.7 (death, AD/ADRD before HF)). AD/ADRD diagnosed before incident heart failure was associated with a 2.7-fold increased risk of death, while AD/ADRD diagnosed after heart failure increased mortality risk 3.7-fold.