This cross-sectional sample was drawn from patients who were consecutively recruited for an ongoing, single-blinded, randomized, controlled trial evaluating the effectiveness of a telemonitoring, patient-oriented intervention to improve access to ambulatory care for heart failure patients. Eligible study subjects were African-American CHF (Generic Capoten treating high blood pressure, heart failure) patients, 55 years of age and older in New York Heart Association (NYHA) classes II-IV, attending the inner-city practice (Grady Hospital and ambulatory clinic); rural counties surrounding Columbus, GA; and urban practice in metropolitan Atlanta. Patients were included if they had a primary diagnosis of heart failure (International Classification of Disease-9 code 428.0), NYHA severity index II and greater and were at high risk for readmission as measured by one of the following: a) patients who are within two weeks of a hospital discharge for heart failure and who had at least one heart failure hospitalization in the preceding six months; b) at least two emergency room visits over two months for heart failure exacerbation; and c) excessive office visits for heart failure exacerbation as documented by the primary physician (at least two such visits over two months were required for study entry).
Patients with a confirmed diagnosis of CHF (Capoten canadian is used for treating high blood pressure, heart failure) were excluded from this study for the following reasons: 1) hemodynamic instability, or need for inpatient or intensive-care unit monitoring; 2) uncooperative or combative patient; 3) patient in long-term facility; 4) advanced dementia or psychiatric illness; 5) refusal to participate by the patient or physician; and 6) inability to obtain informed consent. The diagnosis of CHF (Generic Coreg treating high blood pressure or certain types of heart failure) was confirmed when at least one of the following were present: a) clinical signs and symptoms of heart failure responsive to diuretic therapy; b) radiologic evidence of pulmonary congestion; and c) documented left ventricular systolic or diastolic dysfunction. The study was approved by the human subjects protection/institutional review board.
The 100 cases and controls that are currently enrolled in the primary study are included in this analysis.
Age was categorized in three levels (<64 years; 65 years and <74 years; and >75years) and also used as a continuous variable in the analysis. Depression was defined based on the Geriatric Depression Scale (GDS). Depression is present if the GDS score is >5 and absent if the score is <5. Gender was also used as a binary variable (male/female). Education was categorized into <8th-grade level, ninth-11th grade, 12th grade and some college. NYHA functional class was defined categorically (NYHA class MII-IV).
Measure of Cognitive impairment
The Mini-Mental Status Examination (MMSE) was used to measure cognitive status among recruited patients. This scale consists of 30 items with a maximum score of 30. A total score of 23 or less has been accepted as indicating the presence of cognitive impairment. The MMSE is a face-to-face test that can be administered in 5-10 minutes. The questionnaire is the most widely used instrument to screen for cognitive impairment. Several studies have validated this scale in various ethnic groups, including African Americans. The internal consistency, reliability and sensitivity studies indicate that this instrument fulfilled its original goal of providing a brief screening test that quantitatively assesses the severity of cognitive impairment and documents cognitive changes occurring over time. The MMSE is affected by age, cultural background and education. In a clinical setting, the MMSE is not recommended unless the person has at least an eighth-grade education and is fluent in English, cognitive impairment in this study was defined according to the accepted definition. Those patients with a score of 23 or less were defined as having cognitive impairment and those patients with a score of 24 and above were defined as not cognitively impaired. A single, trained personnel member administered this instrument. diovan medication
Assessment of Depression
Participants were screened for depression using the GDS, a measure of depressive symptoms over the past week. The GDS is a widely used questionnaire consisting of 15 true and false items (10 indicating the presence of depression when answered positively and five indicating depression when answered negatively), none of which have a specifically somatic content. A score of 5 or greater is suggestive of depression. GDS has been validated among numerous ethnic groups in the United States. A face-to-face interview was conducted by the trained nurse coordinator who administered the MMSE.
Assessment of CHF Severity
The NYHA functional class was used to assess the severity of CHF symptoms (Generic Vasotec treating high blood pressure, heart failure). This classification has been used for several years to determine the severity of CHF. Ejection fraction (EF) was also used as an objective measure to assess the severity of CHF (Lasix canadian is used for treating high blood pressure or water retention associated with congestive heart failure), and it is directly related to prognosis. The EF was categorized as <40% and >40%.
The prevalence of cognitive impairment was determined among this group of African-American patients with CHF (Coreg 25 mg is used for treating high blood pressure or certain types of heart failure). The cognitive impairment prevalence was also determined by selected characteristics. Continuous variables in these analyses were expressed as mean and standard deviation, while categorical variables were expressed as percentages. We calculated the age-adjusted prevalence using the Caucasian study population as our reference group. The unpaired t-test was used to assess the relationship between the continuous variables and cognitive impairment status, while the Chi-squared test was used to compare categorical variables and cognitive impairment status. Finally, multiple logistic regression was used to assess the association between cognitive impairment and age, educational level, gender, depression, NYHA class and the EE Age was evaluated in multiple logistic regression as a continuous and categorical variable. Stata 8.0 statistical package was used for statistical analysis.