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Role of a multidisciplinary program in improving outcomes in cognitively impaired heart failure older patients


Del Sindaco, Donatella, Pulignano, Giovanni, Di Lenarda, Andrea, Tarantini, Luigi, Cioffi, Giovanni, Tolone, Stefano, Tinti, Maria Denitza, Monzo, Luca, Barbati, Giulia, Minardi, Giovanni


Monaldi Archives For Chest Disease = Archivio Monaldi Per Le Malattie Del Torace / Fondazione Clinica Del Lavoro, IRCCS [And] Istituto Di Clinica Tisiologica E Malattie Apparato Respiratorio, Università Di Napoli, Secondo Ateneo, Volume: 78, No.: 1, Pages.: 20-28

Year of Publication



Background: Cognitive impairment (CI) frequently complicates Heart failure (HF) and is associated with increased mortality and morbidity. Previous studies reported that nurse-lead home-based multidisciplinary program (MP) may not improve the prognosis of this high-risk group. In the present study, we analysed the relative effectiveness of an integrated hospital-based MP in patients with cognitive impairment.; Methods: Consecutive (n = 173) community-living outpatients aged > 70 years (mean 77 +/- 6, 48% women) randomized to a MP (n = 86) or usual care (UC) (n = 87) were enrolled in stable clinical conditions. Cognitive status was assessed by means of Folstein Mini Mental State Examination (MMSE).; Results: CI (MMSE < or = 24) was present in 41.6% (42,5% UC vs 40.7% MP p =ns). The variables independently associated to CI were: older age, education level <5 years, anemia and severe renal dysfunction. During a 2-year follow-up, 59 patients died (31.4%) with no significant difference between intervention group. At multivariate analysis, in the entire cohort, CI was independently associated to death (HR 2,07 7[95%CI 1,097-3,931]), HF admissions (2,133[1,346-3,381]), death/HF admissions (1,784[1,132-2,811]) and all-cause admissions (1,473[1,008-2,153]. When considered according to intervention groups, CI was independently associated to all-cause death (3,603 [1,553-8,358], death/HF admissions (2,029[1,200-3,432]) and HF admissions (2,474[1,406-4,353]) but not to all-cause admissions. The assignment of patients with CI to MP was associated to a significant reduction in HF admissions vs UC (0,503[0,253-0,999] (all interaction tests p = ns).; Conclusions: This study suggests that CI is very common and associated to worse prognosis in heart failure and that hospital-based MP seems to improve outcomes in these patients through reduction of heart failure hospital admission.;


aged, aged, 80 and over, cognition disorders, complications, failure, female, heart, heart failure, humans, male, patient care team, therapy

Countries of Study


Types of Dementia

Mild Cognitive Impairment (MCI)

Types of Study

Randomised Controlled Trial

Type of Outcomes

Carer Burden (instruments measuring burden), Risk reduction (of dementia and co-morbidities), Service use or cost reductions (incl. hospital use reduction, care home admission delay)


Hospital Inpatient Care

Type of Interventions

Treatment/prevention of co-morbidities or additional risks

Risk Factor Modifications

At risk population