January 27, 2024
3 minute read
Important points:
- Survey data shows that most cardiologists do not screen heart failure patients for cognitive impairment.
- Respondents were positive about a multidisciplinary screening framework, citing a lack of training and time.
Survey data conducted in the Netherlands shows that most cardiologists do not routinely screen elderly heart failure patients for cognitive impairment, but there are dedicated “heart-brain clinics” that provide such complete care. was positive about the idea.
“Current heart failure guidelines address cognitive impairment as a risk factor for poor self-care and recommend significant adjustments to heart failure treatment plans in the case of dementia.” Charlotte M. Neiskens, MD; Professors from the Department of Internal Medicine and Geriatrics at the University of Amsterdam Medical Center write: clinical cardiology. “However, these guidelines lack practical direction on which patients should be screened and when they should be screened, which hinders the provision of personalized care. American Heart Association provide some examples of tools for cognitive screening, but do not recommend when or how to use these tools. This gap in clinical recommendations limits current clinical practice. cases of significant cognitive impairment are more likely to be missed.”
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Nijskens and colleagues distributed an online survey to 55 cardiologists from the Dutch Working Group on Geriatric Cardiology and Heart Failure. The average age of respondents was 48 years, and 62% had more than 10 years of experience in treating heart failure. The survey included 20 multiple-choice questions and two open-ended questions regarding current clinical practice, the impact of cognitive impairment on clinical decision-making, and the knowledge and skills needed to recognize cognitive impairment. It contained questions.
Of the 36 cardiologists who responded to the survey, only 3% had performed structured cognitive screening, and 83% said not enough attention was paid to cognitive impairment. The researchers noted that respondents generally underestimated the prevalence of cognitive impairment, with only 25% accurately estimating the prevalence between 20% and 40%. One in three cardiologists routinely referred patients to geriatricians or neurologists for cognitive analysis.
The survey also showed that 53% of respondents said they were not educated about cognitive issues in patients with heart failure or chronic heart disease during their specialty training. Only 8% said it was the patient’s responsibility to recognize cognitive impairment in heart patients. Most believed it was the responsibility of the geriatrician (14%) or primary care physician (47%).
Most participants (77%) did not think it was feasible to pay more attention to cognition in cardiac care, saying they “wanted clear protocols” and that they knew too little about the condition. It shows that. 80% agreed that patients would benefit from systematic cognitive screening, and 74% wanted to implement a heart-brain clinic.
Establishment of heart and brain clinic
The researchers outlined a step-wise screening program for cognitive impairment for all HF patients, based on the first heart-brain clinic to open at Amsterdam UMC in 2022. At its outpatient cardiovascular clinic, all patients over the age of 60 are screened for a history of delirium, cognitive complaints, and frailty using the Edmonton Frailty Scale. The nurse receives one hour of training to perform this screening.
“Once integrated into clinical routine, this screening takes only 5 minutes to perform during a previous outpatient visit,” the researchers wrote. “If a patient is frail and considered to be at high risk for cognitive impairment, a step-by-step program is provided that includes geriatric assessment, review of medications, and discussion of treatment goals.”
Subsequent geriatric assessments include muscle strength testing, mini-nutritional assessment (brief version), mini-mental status examination, Montreal Cognitive Assessment, and geriatric depression scale.
“If cognitive impairment is suspected, extensive cognitive analysis is performed, including neuropsychological testing and brain MRI,” the researchers wrote. “The results are discussed in a multidisciplinary consensus meeting and a diagnosis is made.”
The clinic focuses on personalized medicine, including prescription elimination, supportive care, home care optimization, and advance care planning.
“Depending on the diagnosis, patients would continue to be under the care of a cardiologist or a geriatrician,” the researchers wrote.
The need for multidisciplinary care
The researchers noted that only cardiologists from the Geriatric Cardiology and Heart Failure Working Group participated in the survey, and that such respondents had a better understanding of heart failure patients than cardiologists who primarily treat younger patients. They added that they were more likely to be aware of the disorder.
“Thus, we may have overestimated cardiologists’ knowledge of cognitive screening and its impact on heart failure treatment,” the researchers wrote. “However, this possibility further emphasizes the need for multidisciplinary heart-brain clinics. These clinics can perform structural screening without the involvement of cardiologists who may be unaware of their patients’ cognitive impairments. It is done.”
