Heart and brain interactions in heart failure: Cognition, depression, anxiety, and related outcomes
Bibliographic record
Abstract
Cognitive impairment, anxiety and depression are common in heart failure (HF) patients and its evolution is not fully understood. To assess the cognitive status of HF patients over time, its relation to anxiety and depression, and its prognostic impact. Prospective, longitudinal, single center study including patients enrolled in a structured program for follow-up after hospital admission for HF decompensation. Cognitive function, anxiety/depression state, HF-related quality of life (QoL) were assessed before discharge and during follow-up (between 6th and 12th month) using Montreal Cognitive Assessment (MoCA), Hospital Anxiety and Depression Scale (HADS) and Kansas City Cardiomyopathy Questionnaire, respectively. HF related outcomes were all cause readmissions, HF readmissions and the composite endpoint of all-cause readmissions or death. 43 patients included (67±11.3 years, 69% male); followed-up for 8.2±2.1 months. 25.6% had an abnormal MoCA score that remained stable during follow-up (22.6±4.2 vs. 22.2±5.5; p=NS). MoCA score <22 at discharge conferred a sixfold greater risk of HF readmission [HR=6.42 (1.26-32.61); p=0.025], also predicting all-cause readmissions [HR=4.00 (1.15-13.95); p=0.03] and death or all-cause readmissions [HR=4.63 (1.37-15.67); p=0.014]. Patients with higher MoCA score showed a greater ability to deal with their disease (p=0.038). At discharge, 14% and 18.6% had an abnormal HADS score for depression and anxiety, respectively, which remained stable during follow-up and was not related to MoCA. Cognitive function, anxiety and depressive status remain stable in HF patients despite optimized HF therapy. Cognitive status shall be routinely screened to adopt attitudes that improve management as it has an impact on HF-related QoL and prognosis. A disfunção cognitiva, ansiedade e depressão são comuns nos doentes com insuficiência cardíaca (IC) e a sua evolução não é integralmente conhecida. Avaliar o estado cognitivo dos doentes com IC ao longo do tempo, a sua relação com ansiedade/depressão e o seu impacto prognóstico. Estudo prospetivo, longitudinal, unicêntrico de doentes seguidos num programa estruturado após internamento por IC descompensada. A função cognitiva, estado ansioso/depressivo, qualidade de vida (QV) relacionada com a IC foram avaliadas antes da alta e durante o seguimento (entre 6.°-12.° mês) utilizando o Montreal Cognitive Assessment (MoCA), a Hospital Anxiety and Depression Scale (HADS) e o Kansas City Cardiomyopathy Questionnaire (KCCQ), respetivamente. Avaliaram-se outcomes relacionados com IC: reinternamento por qualquer causa, reinternamentos por IC e objetivo composto de morte/reinternamento. Foram incluídos 43 doentes (67±11,3 anos, 69% homens); seguidos por 8,2±2,1 meses. 25,6% tinham um resultado anormal no MoCA que se manteve estável no seguimento (22,6±4,2 versus 22,2±5,5; p=NS). Um resultado do MoCA<22 na alta conferiu um risco seis vezes superior de reinternamento por IC[HR=6,42 (1,26-32,61); p=0,025], sendo também preditor de reinternamento por qualquer causa [HR=4,00 (1,15-13,95); p=0,03] e do objetivo composto [HR=4,63 (1,37-15,67); p=0,014]. Doentes com um resultado mais elevado no MoCA apresentaram maior capacidade para lidar com a IC (p=0,038). Na alta, 14% e 18,6% tinham um resultado anormal no HADS para a depressão e ansiedade, respetivamente, que se manteve estável no seguimento e não se associou ao MoCA. O funcionamento cognitivo e o estado ansioso/depressivo mantêm-se estáveis apesar da terapêutica optimizada para a IC. Tendo impacto na QV relacionada com a IC e no prognóstico, a função cognitiva deverá ser rastreada por rotina para adotar atitudes que melhorem a abordagem a estes doentes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".