PMID- 25426862 OWN - NLM STAT- MEDLINE DCOM- 20150720 LR - 20201217 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 9 IP - 11 DP - 2014 TI - Cognitive function in ambulatory patients with systolic heart failure: insights from the warfarin versus aspirin in reduced cardiac ejection fraction (WARCEF) trial. PG - e113447 LID - 10.1371/journal.pone.0113447 [doi] LID - e113447 AB - We sought to determine whether cognitive function in stable outpatients with heart failure (HF) is affected by HF severity. A retrospective, cross-sectional analysis was performed using data from 2, 043 outpatients with systolic HF and without prior stroke enrolled in the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) Trial. Multivariable regression analysis was used to assess the relationship between cognitive function measured using the Mini-Mental Status Exam (MMSE) and markers of HF severity (left ventricular ejection fraction [LVEF], New York Heart Association [NYHA] functional class, and 6-minute walk distance). The mean (SD) for the MMSE was 28.6 (2.0), with 64 (3.1%) of the 2,043 patients meeting the cut-off of MMSE <24 that indicates need for further evaluation of cognitive impairment. After adjustment for demographic and clinical covariates, 6-minute walk distance (beta-coefficient 0.002, p<0.0001), but not LVEF or NYHA functional class, was independently associated with the MMSE as a continuous measure. Age, education, smoking status, body mass index, and hemoglobin level were also independently associated with the MMSE. In conclusion, six-minute walk distance, but not LVEF or NYHA functional class, was an important predictor of cognitive function in ambulatory patients with systolic heart failure. FAU - Graham, Susan AU - Graham S AD - Division of Cardiology, Department of Medicine, State University of New York Upstate Medical University, Buffalo, New York, United States of America. FAU - Ye, Siqin AU - Ye S AD - Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America. FAU - Qian, Min AU - Qian M AD - Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, United States of America. FAU - Sanford, Alexandra R AU - Sanford AR AD - Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, United States of America. FAU - Di Tullio, Marco R AU - Di Tullio MR AD - Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America. FAU - Sacco, Ralph L AU - Sacco RL AD - Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States of America. FAU - Mann, Douglas L AU - Mann DL AD - Department of Medicine, Washington University, St. Louis, Missouri, United States of America. FAU - Levin, Bruce AU - Levin B AD - Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, United States of America. FAU - Pullicino, Patrick M AU - Pullicino PM AD - Kent Institute of Medicine and Health Sciences, University of Kent, Canterbury, United Kingdom. FAU - Freudenberger, Ronald S AU - Freudenberger RS AD - Division of Cardiology, Department of Medicine, Lehigh Valley Hospital, Allentown, Pennsylvania, United States of America. FAU - Teerlink, John R AU - Teerlink JR AD - Section of Cardiology, Department of Medicine, San Francisco Veterans Affairs Medical Center, University of California San Francisco, San Francisco, California, United States of America. FAU - Mohr, J P AU - Mohr JP AD - Department of Neurology, Columbia University Medical Center, New York, New York, United States of America. FAU - Labovitz, Arthur J AU - Labovitz AJ AD - Department of Cardiovascular Medicine, University of South Florida, Tampa, Florida, United States of America. FAU - Lip, Gregory Y H AU - Lip GY AD - University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom. FAU - Estol, Conrado J AU - Estol CJ AD - Centro Neurologico de Tratamiento y Rehabilitacion, Buenos Aires, Argentina. FAU - Lok, Dirk J AU - Lok DJ AD - Department of Cardiology, Deventer Hospital, Deventer, Overijssel, The Netherlands. FAU - Ponikowski, Piotr AU - Ponikowski P AD - Department of Heart Diseases, Wroclaw Medical University, Military Hospital, Wroclaw, Lower Silesia, Poland. FAU - Anker, Stefan D AU - Anker SD AD - Department of Innovative Clinical Trials, University Medical Centre Gottingen, Gottingen, Lower Saxony, Germany. FAU - Thompson, John L P AU - Thompson JL AD - Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, United States of America. FAU - Homma, Shunichi AU - Homma S AD - Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, United States of America. CN - WARCEF Investigators LA - eng GR - U01-NS-043975/NS/NINDS NIH HHS/United States GR - U01 NS043975/NS/NINDS NIH HHS/United States GR - U01-NS-039143/NS/NINDS NIH HHS/United States GR - U01 NS039143/NS/NINDS NIH HHS/United States GR - K23 HL121144/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural DEP - 20141126 PL - United States TA - PLoS One JT - PloS one JID - 101285081 RN - 0 (Fibrinolytic Agents) RN - 5Q7ZVV76EI (Warfarin) RN - R16CO5Y76E (Aspirin) SB - IM MH - Age Factors MH - Aged MH - Aspirin/*therapeutic use MH - Body Mass Index MH - *Cognition MH - Cross-Sectional Studies MH - Educational Status MH - Exercise Tolerance MH - Female MH - Fibrinolytic Agents/*therapeutic use MH - Heart Failure, Systolic/diagnosis/*drug therapy/physiopathology MH - Humans MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Outpatients MH - Retrospective Studies MH - Severity of Illness Index MH - Smoking/physiopathology MH - Stroke Volume MH - Ventricular Function, Left MH - Walking MH - Warfarin/*therapeutic use PMC - PMC4245133 COIS- Competing Interests: Dr. Homma reports receiving payment from AGA Medical (now St. Jude Medical) for his work as a member of a data and safety monitoring board and consulting fees from Boehringer Ingelheim; Dr. Levin reports receiving consulting fees from United Healthcare; Dr. Teerlink reports receiving consulting fees from Amgen and grant support from Amgen, Cytokinetics, and Novartis on behalf of himself and from NovaCardia/Merck on behalf of himself and his institution; Dr. Graham reports owning stock in March Pharmaceuticals, Medtronic, and Pfizer; Dr. Labovitz reports receiving grant support from Boehringer Ingelheim on behalf of his institution, lecture fees from Boehringer Ingelheim, and fees for the development of educational presentations from the American College of Cardiology; Dr. Anker reports receiving consulting fees from Amgen, Bosch Healthcare, GlaxoSmithKline, Helsinn, LoneStar Heart, Novartis, Professional Dietetics, PsiOxus, Relypsa, SHL Telemedicine, and Thermo Fisher, grant support from Vifor Pharma, and lecture fees from Novartis, holding patents with Brahms AG and Charite Berlin, and receiving royalties from Imperial College; Dr. Ponikowski reports receiving consulting fees from Bayer, Boehringer Ingelheim, Coridea, Corthera, Johnson & Johnson, Pfizer, Respicardia, and Vifor Pharma, grant support from Vifor Pharma on behalf of himself and his institution, and lecture fees from Abbott, Boehringer Ingelheim, Merck Serono, Pfizer, Respicardia, Sanofi-Aventis, Servier, and Vifor Pharma; and Dr. Lip reports receiving consulting fees from Astellas, AstraZeneca, Bayer, Biotronik, Boehringer Inhelheim, Bristol-Myers Squibb, Pfizer, Merck, Portola, and Sanofi-Aventis, speakers bureau fees from Bayer, Bristol-Myers Squibb, Pfizer, Boehringer Ingelheim, and Sanofi-Aventis, and payment for the development of educational presentations from Bayer, Boehringer Ingelheim, and Merck. No other potential conflict of interest relevant to this article was reported. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials. FIR - Homma, S IR - Homma S FIR - Thompson, J L P IR - Thompson JL FIR - Pullicino, P IR - Pullicino P FIR - Freudenberger, R IR - Freudenberger R FIR - Graham, S IR - Graham S FIR - Teerlink, J IR - Teerlink J FIR - Ammon, S IR - Ammon S FIR - Mann, D IR - Mann D FIR - Mohr, J P IR - Mohr JP FIR - Sacco, R L IR - Sacco RL FIR - Massie, B IR - Massie B FIR - Anker, S IR - Anker S FIR - Labovitz, A IR - Labovitz A FIR - Moy, C IR - Moy C FIR - Moy, C IR - Moy C FIR - Gilbert, P IR - Gilbert P FIR - Gutmann, L IR - Gutmann L FIR - Marler, J IR - Marler J FIR - Homma, S IR - Homma S FIR - Mejia, V IR - Mejia V FIR - Gabriel, A IR - Gabriel A FIR - Czaja, P IR - Czaja P FIR - Gaciong, Z IR - Gaciong Z FIR - Gora, J IR - Gora J FIR - Kleinrok, A IR - Kleinrok A FIR - Prokop-Lewicka, G IR - Prokop-Lewicka G FIR - Haddad, H IR - Haddad H FIR - Davies, R IR - Davies R FIR - Sitwell, L IR - Sitwell L FIR - Donaldson, J IR - Donaldson J FIR - To, T IR - To T FIR - Yufe, R IR - Yufe R FIR - Donelly, B IR - Donelly B FIR - Huynh, T IR - Huynh T FIR - Cote, R IR - Cote R FIR - St Jacques, B IR - St Jacques B FIR - Borts, D IR - Borts D FIR - Tullio, G IR - Tullio G FIR - Sindilar, A M IR - Sindilar AM FIR - Winder, T IR - Winder T FIR - Janzen, E IR - Janzen E FIR - Walker, C IR - Walker C FIR - Moe, G IR - Moe G FIR - Bayer, N IR - Bayer N FIR - Konig, A IR - Konig A FIR - Arnold, M IR - Arnold M FIR - Spence, D IR - Spence D FIR - Smith, J IR - Smith J FIR - Bessoudo, R IR - Bessoudo R FIR - Bailey, P IR - Bailey P FIR - McNulty, A IR - McNulty A FIR - Nawaz, S IR - Nawaz S FIR - Dewar, C IR - Dewar C FIR - Rajda, M IR - Rajda M FIR - MacFarlane, M IR - MacFarlane M FIR - Minuk, J IR - Minuk J FIR - Schanz, C IR - Schanz C FIR - Penn, A IR - Penn A FIR - Atkins, L IR - Atkins L FIR - Ducharme, A IR - Ducharme A FIR - Brown, H IR - Brown H FIR - Zieroth, S IR - Zieroth S FIR - Munoz, A IR - Munoz A FIR - Lok, D IR - Lok D FIR - ten Holter, J B M IR - ten Holter JB FIR - Huls, C IR - Huls C FIR - Bruggink-Andre, P IR - Bruggink-Andre P FIR - van Bujisen-Nutters, A IR - van Bujisen-Nutters A FIR - Ziekenhuis IR - Ziekenhuis FIR - Daniels, M IR - Daniels M FIR - Coppes, A IR - Coppes A FIR - van Zagten, M IR - van Zagten M FIR - Elzebroek, N IR - Elzebroek N FIR - Hamroui, K IR - Hamroui K FIR - de Kort, P L M IR - de Kort P FIR - Vuijsters, J IR - Vuijsters J FIR - Holwerda, N IR - Holwerda N FIR - Hermans, W IR - Hermans W FIR - van der Loo, R IR - van der Loo R FIR - Wajon, E IR - Wajon E FIR - Hageman, G IR - Hageman G FIR - Buchem-Damming, G v IR - Buchem-Damming G FIR - Ronner, E IR - Ronner E FIR - Wissenburg-van Lieshout, A IR - Wissenburg-van Lieshout A FIR - Niekus, H IR - Niekus H FIR - van Hessen, M W J IR - van Hessen MW FIR - Verheul, G A M IR - Verheul GA FIR - Linssen, G IR - Linssen G FIR - te Pas, L IR - te Pas L FIR - Plomp, J IR - Plomp J FIR - de Milliano, P A R IR - de Milliano PA FIR - Breedveld, R IR - Breedveld R FIR - Bos, M J IR - Bos MJ FIR - Houra, M IR - Houra M FIR - Beran, D IR - Beran D FIR - Lebedova, R IR - Lebedova R FIR - Carda, J IR - Carda J FIR - Bednarova, E IR - Bednarova E FIR - Vosmerova, J IR - Vosmerova J FIR - Marcinek, G IR - Marcinek G FIR - Drasnar, T IR - Drasnar T FIR - Najmanova, O IR - Najmanova O FIR - Dunaj, M IR - Dunaj M FIR - Pechackova, E IR - Pechackova E FIR - Kuchar, M IR - Kuchar M FIR - Jansky, P IR - Jansky P FIR - Simon, J IR - Simon J FIR - Dvorakova, H IR - Dvorakova H FIR - Gregor, P IR - Gregor P FIR - Maruskova, M IR - Maruskova M FIR - Svoboda, L IR - Svoboda L FIR - Lorenc, Z IR - Lorenc Z FIR - Kralicek, P IR - Kralicek P FIR - Pollak, L IR - Pollak L FIR - Krobot, M IR - Krobot M FIR - Spinar, J IR - Spinar J FIR - Nemec, M IR - Nemec M FIR - Spinarova, L IR - Spinarova L FIR - Kuba, R IR - Kuba R FIR - Padour, F IR - Padour F FIR - Padourova, I IR - Padourova I FIR - Padour, M IR - Padour M FIR - Michalova, M IR - Michalova M FIR - Golan, L IR - Golan L FIR - Hajkova, M IR - Hajkova M FIR - Povolny, J IR - Povolny J FIR - Krizova, L IR - Krizova L FIR - Horak, D IR - Horak D FIR - Kucera, P IR - Kucera P FIR - Malek, I IR - Malek I FIR - Krizova, B IR - Krizova B FIR - Svoboda, J IR - Svoboda J FIR - Ferkl, R IR - Ferkl R FIR - Regos, L IR - Regos L FIR - Csuros, L IR - Csuros L FIR - Lovasz, O IR - Lovasz O FIR - Kiss, G IR - Kiss G FIR - Timar, S IR - Timar S FIR - Torok, N IR - Torok N FIR - Hajnalne, A IR - Hajnalne A FIR - Palossy, B IR - Palossy B FIR - Nagy, A IR - Nagy A FIR - Fulop, P IR - Fulop P FIR - Jakab, G IR - Jakab G FIR - Ronaszeki, A IR - Ronaszeki A FIR - Bodi, M IR - Bodi M FIR - Satori, M IR - Satori M FIR - Edes, I IR - Edes I FIR - Varga, I IR - Varga I FIR - Kovacs, A IR - Kovacs A FIR - Berente, L IR - Berente L FIR - Peterfai, E IR - Peterfai E FIR - Pauer, R IR - Pauer R FIR - Toth, K IR - Toth K FIR - Nagy, E IR - Nagy E FIR - Benczur, B IR - Benczur B FIR - Karsay, K IR - Karsay K FIR - Vegh, T IR - Vegh T FIR - Nagy, R IR - Nagy R FIR - Karpati, P IR - Karpati P FIR - Davidovits, Z IR - Davidovits Z FIR - Borbola, J IR - Borbola J FIR - Vanyi, J IR - Vanyi J FIR - Oze, B IR - Oze B FIR - Bujdoso, A IR - Bujdoso A FIR - Kosa, I IR - Kosa I FIR - Baliko, L IR - Baliko L FIR - Natour, M IR - Natour M FIR - Morgil, M IR - Morgil M FIR - Hartmann, E IR - Hartmann E FIR - Morgil, H IR - Morgil H FIR - Winkler, R IR - Winkler R FIR - Gass, S IR - Gass S FIR - Baumann, S IR - Baumann S FIR - Jeserich, M IR - Jeserich M FIR - Rodl, J IR - Rodl J FIR - Dzaiy, M IR - Dzaiy M FIR - Anker, S IR - Anker S FIR - Turhan, G IR - Turhan G FIR - Wolf, K IR - Wolf K FIR - Genth-Zotz, S IR - Genth-Zotz S FIR - Siebert, T IR - Siebert T FIR - Jakobs, C IR - Jakobs C FIR - Kiorwantsi, M IR - Kiorwantsi M FIR - Pieske, B IR - Pieske B FIR - Wachter, R IR - Wachter R FIR - Schoenauer, M IR - Schoenauer M FIR - Voigt, S IR - Voigt S FIR - Schunkert, H IR - Schunkert H FIR - Boguschewski, A IR - Boguschewski A FIR - Resch, M IR - Resch M FIR - Wensel, R IR - Wensel R FIR - Schumann, V IR - Schumann V FIR - Heidrich, P IR - Heidrich P FIR - Girina, O IR - Girina O FIR - Prokopovych, Y IR - Prokopovych Y FIR - Lebedynska, M IR - Lebedynska M FIR - Sorokina, I IR - Sorokina I FIR - Karpenko, O IR - Karpenko O FIR - Brodi, N IR - Brodi N FIR - Klochkov, S IR - Klochkov S FIR - Voronkov, L IR - Voronkov L FIR - Besaga, Y IR - Besaga Y FIR - Novikova, O IR - Novikova O FIR - Amosova, K IR - Amosova K FIR - Yaremenko, O IR - Yaremenko O FIR - Balaban, K IR - Balaban K FIR - Kovalenko, V IR - Kovalenko V FIR - Polenova, N IR - Polenova N FIR - Sakharchuk, I IR - Sakharchuk I FIR - Ogorodnichuk, A IR - Ogorodnichuk A FIR - Rudenko, L IR - Rudenko L FIR - Tutov, Y IR - Tutov Y FIR - Parkhomenko, A IR - Parkhomenko A FIR - Kozhukhov, S IR - Kozhukhov S FIR - Yakimenko, E IR - Yakimenko E FIR - Kolomiets, S IR - Kolomiets S FIR - Yurlov, V IR - Yurlov V FIR - Tikhonova, S IR - Tikhonova S FIR - Estol, C IR - Estol C FIR - Elizalde, A IR - Elizalde A FIR - Mangariello, B IR - Mangariello B FIR - Zaidman, C IR - Zaidman C FIR - Guerlloy, F IR - Guerlloy F FIR - Gitelman, P IR - Gitelman P FIR - Crotto, K IR - Crotto K FIR - Sassone, S IR - Sassone S FIR - Aiub, J IR - Aiub J FIR - Novoa, F IR - Novoa F FIR - Lopez Santi, R IR - Lopez Santi R FIR - Romia, P IR - Romia P FIR - Montana, O IR - Montana O FIR - Malchik, D IR - Malchik D FIR - F Sokn IR - F Sokn FIR - Schygiel, P IR - Schygiel P FIR - Porcile, R IR - Porcile R FIR - Soria Tito, F IR - Soria Tito F FIR - Thierer, J IR - Thierer J FIR - Avellana, P IR - Avellana P FIR - Rapallo, C IR - Rapallo C FIR - Calderon, M IR - Calderon M FIR - MacFadyen, R IR - MacFadyen R FIR - Haynes, R IR - Haynes R FIR - Partridge, J IR - Partridge J FIR - Derera, L IR - Derera L FIR - Kokles, M IR - Kokles M FIR - Mehesova, S IR - Mehesova S FIR - Zachar, A IR - Zachar A FIR - Hranai, M IR - Hranai M FIR - Varadyova, T IR - Varadyova T FIR - Gobo, T IR - Gobo T FIR - Litvinova, J IR - Litvinova J FIR - Loviska, P IR - Loviska P EDAT- 2014/11/27 06:00 MHDA- 2015/07/21 06:00 PMCR- 2014/11/26 CRDT- 2014/11/27 06:00 PHST- 2014/07/26 00:00 [received] PHST- 2014/10/24 00:00 [accepted] PHST- 2014/11/27 06:00 [entrez] PHST- 2014/11/27 06:00 [pubmed] PHST- 2015/07/21 06:00 [medline] PHST- 2014/11/26 00:00 [pmc-release] AID - PONE-D-14-33586 [pii] AID - 10.1371/journal.pone.0113447 [doi] PST - epublish SO - PLoS One. 2014 Nov 26;9(11):e113447. doi: 10.1371/journal.pone.0113447. eCollection 2014.