Abstract WMP16: Race, Gender, And Cognition In Heart Failure

Background: Cognitive impairment is prevalent in the heart failure (HF) population, eventually complicating the disease course in over 50%. Disease management and risk factor control are thought to play a role. Disparities in healthcare utilization and access may also contribute. We hypothesize gender, ethnic and racial disparities in HF contribute to accelerated cognitive decline. Methods: We performed a cross-sectional analysis of study participants age ≥ 60 years in the biannual NHANES survey. Medical history, clinical variables, and Digit Symbol Substitution Test (DSST) scores from cycles 1999, 2001, 2011, and 2013 were extracted. The DSST assesses visuomotor, attention, and processing speed, and in prior studies was found to be strongly associated with vascular-related cognitive impairment. Survey-weighted regression models adjusting for age, race, gender, education, vascular risk factors and history of stroke were used to generate nationally representative estimates. Results: 6,651 study participants representing 51,841,223 adults ≥ 60 years were included, 7% with prevalent HF. Participants with HF were older (73.8 vs 70.0, P <0.001) but there were no significant differences in the proportion of women or in the racial/ethnic makeup of participants with and without HF. Stroke was 3 times more prevalent in the HF population (20.1% vs 6.5%, P <0.001). Individuals with HF had significantly lower DSST scores (mean 39.6 [0.97] vs 50.2 [0.45], P<0.001). We found a significant interaction between HF and sex (P <0.10). Among men, prevalent HF was associated with a 2.95 (95% CI: -4.75, -1.16) decrease in DSST. In women, larger decreases in cognition were observed (-5.18, 95% CI: -7.34, -3.02). There was no interaction between heart failure and race. Conclusions: Women with HF experience greater levels of HF-related cognitive impairment. These differences may be a consequence of known differential rates of early HF detection and disease maintenance across genders.