The Complex Relationship of Cognitive and Sensory Impairments With Risk of Hospitalization in Adults With Heart Failure

BACKGROUND: Individuals with heart failure (HF) often have multiple complicating comorbidities. We examined whether cognitive and sensory (vision and hearing) impairments were independently associated with the risks of being hospitalized for HF or any cause in adults with HF. METHODS: We conducted a retrospective cohort study among adults with HF from four US integrated healthcare delivery systems from 2005 to 2012. The presence of cognitive and sensory impairments were defined based on ICD-9 codes. We evaluated the association of cognitive and sensory impairments with hospitalization for HF and hospitalization for any cause using Fine-Gray subdistribution hazard models, accounting for competing risks of death or health plan disenrollment. RESULTS: Among 43,358 eligible adults with HF, the mean age was 71.6 years, 43% were women, 26% were racial/ethnic minorities; 1104 had both cognitive and sensory impairments; 1079 had only cognitive impairment; 14,207 had only sensory impairment; and 26,968 had neither documented impairment at study entry. Individuals with both impairments had the lowest adherence to HF-related medications as compared to those without impairments. After adjustment for several potential confounders and accounting for competing risk of death, compared to individuals without any documented impairment, those with only cognitive impairment and those with both impairments experienced a lower risk of HF-related hospitalization (adjusted hazard ratio [aHR], 0.71 95% CI: 0.63-0.80) and (aHR 0.70 95% CI: 0.62-0.80), respectively. Similar trends were found for hospitalization for any cause. CONCLUSION: In a diverse population of adults with HF, we observed a counterintuitive association between cognitive and sensory impairments and risks for hospitalization. Potential reasons include unmeasured confounders and receipt of care at home or through other non-hospital facilities. More detailed studies are needed to fully delineate the impact of these impairments and to elucidate potential effective management strategies in this growing population.