Relationship between Cognitive Function, Depression/Anxiety and Functional Parameters in Patients Admitted for Congestive Heart Failure.

UNLABELLED: Cognitive impairment, anxiety and depression have been described in patients with congestive heart failure (CHF). We analyzed in-hospital CHF patients before discharge with neuropsychological tests attempting to correlate with prognostic parameters. METHODS: All subjects underwent a mini mental state examination (MMSE), geriatric depression scale (GDS), anxiety and depression scale test (HADS). We evaluated NYHA class, brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF) and non-invasive cardiac output (CO). RESULTS: Three-hundred and three CHF patients (age 71.6 ys) were analysed. The mean NYHA class was 2.9±0.8, LVEF was 43.4±15.8%; BNP plasma level and CO were calculated as 579.8±688.4 pg/ml and 3.9±1.1 l/min, respectively. In 9.6% a pathological MMSE score emerged; a depression of mood in 18.2% and anxiety in 23.4% of patients were observed. A significant correlation between MMSE and age (r=0.11 p=0.001), BNP (r=0.64 p=0.03) but not between MMSE and NYHA class and LVEF was observed. GDS and HADS were inversely correlated with NYHA class (r=0.38 p=0.04) and six-minute walking test (r=0.18 p=0.01) without an association with objective parameters in CHF (BNP, LVEF and cardiac output). At multivariate analysis only MMSE and BNP are inversely correlated significantly (p=0.019 OR=-0.64, CI=-042-0.86). CONCLUSIONS: in-hospital CHF patients may manifest a reduction of MMSE and important anxiety/depression disorders. The results of the study suggest that the presence of cognitive impairment in older CHF patients with higher BNP plasma level should be considered. In admitted CHF patients anxiety and depression of mood are commonly reported and influenced the perception of the severity of illness.

[Efficacy of team work in health promotion and secondary prevention in patients admitted for cardiovascular rehabilitation]. / Efficacia del lavoro di gruppo nella informazione sanitaria e prevenzione secondaria in pazienti afferenti alla riabilitazione cardiologica.

UNLABELLED: The object of the study was to evaluate the immediate efficacy of periodical educational meetings organized in Cardiovascular Rehabilitation Department aimed to improve knowledge about cardiovascular pathology, risk factors and correct life style. METHODS: From October 2008 a multiprofessional group organized educational meetings for patients and their relatives, using two questionnaires to explore patients' level of knowledge, before and after the meeting. RESULTS: 124 patients (90 males) answered the questionnaire 1, while questionnaire 2 was completed by 93 subjects (70 males). From the answers to questionnaire 1, a significant improvement of knowledge about coronary anatomy and cardiovascular therapy emerged. Indeed, 99% of patients vs 81% before the meeting (p=0.001) understood the coronary artery function, 69% vs 44% (p=0,0001) of participants was familiar with coronary angioplasty, 81% vs. 64% (p=0,003) demonstrated to understand the coronary artery bypass and finally 85% vs. 52% (p=0,0001) were able to distinguish mechanical from biological prosthesis. From answers to questionnaire 2, a trend in favour to an improvement of knowledge regarding coronary risk factors and correct life style emerged. Younger patients (<70 ys) had a higher baseline level knowledge (p=0,003 and p=0.001 group 1 and 2, respectively) compared to older subjects, but in the latter a trend in favour of enhanced knowledge (p=0.06) after the educational meetings emerged. CONCLUSIONS: Educational meetings are significantly correlated with an improvement of patients' knowledge regarding cardiovascular pathology and treatments independently from patients' age.

Correlation between cognitive impairment and prognostic parameters in patients with congestive heart failure.

BACKGROUND: Cognitive impairment has been observed in patients with congestive heart failure (CHF). We analyzed in-hospital CHF patients with neuropsychological tests attempting to correlate the results with prognostic parameters. METHODS: All subjects underwent a mini-mental state examination (MMSE), memory and learning tests (Corsi Block-tapping test, Verbal Span test, Prose Memory test, Visual Search), anxiety and depression scale test. New York Hospital Association (NYHA) class, brain natriuretic peptide (BNP) and left ventricular ejection fraction (LVEF) were evaluated. RESULTS: Sixty patients (mean age 65.5 years) were analyzed. NYHA class was 2.9 +/- 0.9, LVEF was 32.9 +/- 13.7%, BNP plasma level 683.3 +/- 864.3 pg/mL. In 23.3% of cases a pathological MMSE score emerged; memory and learning test results were abnormal in 3.4-37%. A positive correlation between MMSE and age (r = 0.18, p = 0.01), BNP (r = 0.25, p = 0.02) was observed but not between MMSE and years of education, NYHA class and LVEF. The Corsi Block-tapping test was related to educational duration (r = 0.12, p = 0.02) with a positive trend for BNP (r = 0.2, p = 0.07). The Prose Memory test and Visual Search were influenced by the patients' educational level (r = 0.36, p = 0.0001; r = 0.27, p = 0.0001). CONCLUSIONS: CHF patients manifest an impairment of MMSE and memory and learning test performance. In our population MMSE correlates to plasma BNP and advanced age.