Doctors miss memory problems in heart patients
NEW YORK (Reuters Health) - Almost half of older heart patients in a new study had memory loss, though their cardiologists failed to recognize the impairment most of the time.
"Detection of memory impairment is very important in elderly heart failure patients," the study's lead author, Dr. Olivier Hanon, told Reuters Health in an email.
Memory loss may affect how well people with heart failure stick to their medications, said Hanon, from Broca Hospital in Paris. Their chances of dying are known to increase with their thinking and memory problems.
Hanon and his colleagues studied 912 people who were at least 70 years old, hospitalized for heart failure in the past year and under the care of one of nearly 300 private practice cardiologists throughout France in 2009.
Heart doctors rated their patients' cognitive ability as either normal or impaired before administering a four-word recall test.
Based on the screening test, cardiologists diagnosed memory shortfalls in 46 percent of patients. They had recognized deficiencies in only 12 percent before testing, the researchers reported in The American Journal of Cardiology.
Past studies have also tied heart disease to memory loss. One recent report, for instance, found older women with a history of heart trouble were more likely to develop memory problems than women with healthy hearts (see Reuters Health story of January 3, 2014 here: reut.rs/1di55am).
Other earlier studies showed cardiologists significantly underestimated memory problems - a marker for cognitive decline, Hanon's team reported.
Though doctors' failure to recognize memory loss has been widely documented, Hanon said the pervasiveness of missed diagnoses surprised him.
"Cardiologists were mainly misled by patients with memory impairment who . . . appeared 'normal,' " he said.
Cognitively impaired people are less likely to take their medications, show up for appointments and make recommended diet changes, the authors write. Early identification of memory changes through testing would enable cardiologists to develop strategies to help patients stick to their treatment plans, they say.
Hanon recommended that cardiologists test thinking and memory skills when they first examine patients and each year thereafter.
But cardiologist Dr. Liviu Klein of the University of California San Francisco Medical Center told Reuters Health he disagrees that cardiologists should routinely perform memory tests.
Klein, who was not involved in the current study, said he tests patients for memory impairment before they receive invasive therapies, like heart transplants, which would be inappropriate for dementia patients.
Outside of those instances, he said he believes testing for memory problems should fall to primary care physicians.
"As cardiologists, our training is to deal with heart issues," he said. "We're not trained to deal with other issues."
If cardiologists were expected to test for cognitive impairment, they might also have to test for depression and other ailments, Klein said.
"Then you have a patient who comes to see you for half an hour, and they spend three hours," he said. "And they don't really like that."
But primary care physicians may not routinely be testing thinking and memory skills either. A 2010 German study found only 11 to 12 percent of general practitioners recognized mild cognitive impairment in their patients, Hanon's paper noted.
The current study showed that severity of memory impairment increased along with severity of heart failure. However, that association seemed to be at least partly explained by differences in education, exercise habits, depression and other diseases between people with different stages of heart failure.
Participants were taking an average of more than four heart medications each. The authors found no differences in memory loss based on treatment, Hanon said. He could not rule out that specific antidepressants impaired cognition.
Hanon and five of the six other authors reported receiving honoraria from Menarini, an Italian pharmaceutical group that makes cardiovascular products and also funded the study.
SOURCE: bit.ly/1jACVN8 The American Journal of Cardiology, online January 16, 2014.