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Background Cognitive impairment (CI) is estimated to be present in 25%–80% of heart failure (HF) patients, but its prevalence at diagnosis is unclear. To improve our understanding of cognition in HF, we determined the prevalence of CI among adults with incident HF in the REGARDS study. Methods and Results REGARDS is a longitudinal cohort study of adults ≥45 years of age recruited in the years 2003–2007. Incident HF was expert adjudicated. Cognitive function was assessed with the Six-Item Screener. The prevalence of CI among those with incident HF was compared with the prevalence of CI among an age-, sex-, and race-matched cohort without HF. The 436 participants with incident HF had a mean age of 70.3 years (SD 8.9), 47% were female, and 39% were black. Old age, black race, female sex, less education, and anticoagulation use were associated with CI. The prevalence of CI among participants with incident HF (14.9% [95% CI 11.7%–18.6%]) was similar to the non-HF matched cohort (13.4% [11.6%–15.4%]; P Conclusions A total of 14.9% of the adults with incident HF had CI, suggesting that the majority of cognitive decline occurs after HF diagnosis. Increased awareness of CI among newly diagnosed patients and ways to mitigate it in the context of HF management are warranted.

Introduction Readmissions within 30 days of left ventricular assist device (LVAD) implantation are common, contributing to increased morbidity and cost. The relationship between hospital volume and outcomes after LVAD implantation has not been well established. The purpose of this study was to examine 30-day readmission rates after LVAD implantation, stratified by hospital volume, using the Nationwide Readmissions Database (NRD), an all-payer administrative database. Methods Using the 2014 NRD, we examined 1,311 adults discharged following LVAD implantation in January-November 2014. We identified LVAD implantations based on ICD-9-CM procedure code 37.66 and excluded patients with concurrent ICD-9-CM codes of heart transplantation (37.51 and 33.60). LVAD site volume was determined by counting the number of LVAD implantations from January through December 2014 at each hospital. We then classified patients into site volume quartiles (≤ 23, 24-40, 41-49, and ≥ 50). To determine whether LVAD site volume was independently associated with all-cause 30-day readmission, we conducted multivariable logistic regression accounting for the sample design and adjusting for age, sex, payer status, income quartile, Elixhauser weighted comorbidity index, discharge disposition, pre-LVAD mechanical circulatory support, and length of stay. Results Among 1,311 patients discharged following LVAD implantation, 363 (27%) were readmitted within 30 days. Patients who experienced an LVAD implantation at a hospital in the lowest quartile of LVAD volume were more likely to have higher comorbidity burden, longer index hospitalization length of stay, and have had their implantation at a smaller hospital (bed size Conclusion LVAD site volume was not associated with 30-day readmission. This suggests that regulatory processes in place to ensure high quality LVAD care across sites in the United States have been effective independent of volume.

Introduction About half of HF hospitalizations result from a cardiovascular cause. Identifying patients who are more likely to experience a cardiovascular (CV) readmission (and those who are more likely to experience a non-cardiovascular readmission) could have important implications on developing effective strategies to reduce 30-day readmission. We sought to determine if a simple count of cardiac conditions could predict CV-specific 30-day readmission. Methods Using the Nationwide Readmissions Database, we examined all discharges in January-November 2014 following a hospitalization with a principal diagnosis of HF. We created a count based on the presence of three common and easily identifiable cardiac conditions (coronary artery disease [CAD], atrial arrhythmia, and ventricular arrhythmia) using ICD-9-CM codes. We used multinomial logistic regression to determine if a count of cardiac conditions was independently associated with CV readmission or non-CV readmission (relative to no readmission), adjusting for age, sex, payer status, annual income, comorbidity burden (Elixhauser index), and hospital bed size and urban vs. rural location. Results Among 380,075 patients, 51% had CAD, 43% had an atrial arrhythmia, and 5% had a ventricular arrhythmia. The 30-day all-cause readmission rate was 20%; 55% were from CV causes. CAD, atrial arrhythmia, and ventricular arrhythmia were each associated with increased risk for 30-day CV readmission. About 28% had 0 cardiac comorbidities, 47% had 1, 23% had 2, and 2% had 3. When adjusting for potential patient- and hospital-level confounders, cardiac comorbidity count was independently associated with CV readmission, and was not associated with non-CV readmission (Table). The association between cardiac comorbidity count and CV-readmission were largely similar across age strata and tertiles of comorbidity burden (Table). Conclusion A simple cardiac comorbidity count (comprised of CAD, atrial arrhythmia, and ventricular arrhythmia) was significantly associated with 30-day CV readmissions. This count can be calculated at the patient's bedside and may provide a simple strategy to identify HF patients who would benefit from strategies targeted specifically to reduce CV-readmissions.

Introduction Hyperpolypharmacy (HPP), defined as the use of ≥10 medications, is a well-described phenomenon in Geriatrics, that is linked to increased risk for hospitalization, disability, and mortality. Given the number of cardiovascular medications necessary to adhere to clinical practice guidelines, coupled with a high prevalence of non-cardiac comorbidity, adults with CHF may be at elevated risk for HPP. Objective We aimed to assess the prevalence and identify determinants of HPP among adults with CHF. Methods Using 2003-2014 data from NHANES (a cross-sectional survey representative of the non-institutionalized population in the United States), we examined adults aged ≥50 years with self-reported CHF. We defined HPP as the condition of taking ≥10 medications. We used weighted means and percentages to determine population-based characteristics. To identify factors independently associated with HPP, we performed a multivariable Poisson regression analysis, adjusting for sociodemographics, comorbidity, geriatric conditions, and health care utilization. Results We studied 947 participants with CHF, which represented 4.6 million adults with CHF in the USA. The mean age of the population was 70 years, 49% were women, and 77% were white. Most participants had an education level of high school or below (87%), and a substantial proportion (27%) reported an annual household income of Conclusion Hyperpolypharmacy is common in adults with CHF. While its prevalence does not vary according to impairments in function or cognition, low household income and low educational status are independently associated with HPP. This suggests that non-medical factors may be contributing to this potentially harmful practice, and warrants further investigation.

Background Patients with CHF take a large number of medications. High medication burden (i.e. polypharmacy) is associated with adverse outcomes, especially among those with impairments in activities of daily living (ADLs). Whether CHF patients with ADL impairment have lower medication burden is unknown. Objective To compare the number of medications taken by adults with CHF according to the presence of ADL impairment. Methods We examined adults aged ≥50 years old with self-reported CHF from the National Health and Nutrition Examination Surveys (NHANES) (2003-2014), cross-sectional surveys that produce national estimates of adult non-institutionalized United States civilians. ADL impairments were defined as impairments in transferring, eating, and/or dressing. To determine the independent association between ADL impairment and medication count, we performed sequential Poisson multivariable regression analyses, guided by the Andersen health care utilization model of predisposing, enabling, and need factors. We first determined the crude association between ADL impairment and medication count and then sequentially added predisposing factors, enabling factors, comorbidity count, other need factors, and lastly healthcare utilization factors. Results We studied 947 participants, which represented a non-institutionalized adult population in the USA of approximately 4.6 million adults with CHF. The mean age was 70 years, the mean medication count was 7.2 [95 % CI (6.8 - 7.5)], and 74% were on ≥5 medications (i.e., polypharmacy). In a crude model, ADL impairment was associated with a 23% increase in medication count. Upon the addition of comorbidity to the model, this association was no longer present ( Table 1 ). In the fully adjusted model, ADL impairment was not independently associated with medication count. These findings were similar for those with ≥3 hospitalizations in the prior year, declining health status, and cognitive impairment. Conclusion After adjusting for confounders including comorbidity, adults with CHF and ADL impairment took just as many medications as those with CHF and no ADL impairment even after accounting for recurrent hospitalizations, declining health, and cognitive impairment. This suggests that providers may not sufficiently consider functional status and/or prognosis when prescribing medications to adults with CHF, and thus may be unnecessarily exposing a large number of individuals to an increased risk for adverse outcomes.