Care of Patients with Chronic Heart Failure Cognitive impairment and medication adherence in outpatients with heart failure Lee Ann Hawkins, PhD(c), NP*, Shirley Kilian, PhD, Anthony Firek, MD, T. Michael Kashner, PhD, Christopher J. Firek, BA, Helme Silvet, MD, MPH VA Loma Linda Healthcare System, Loma Linda, California article info Article history: Received 7 November 2011 Revised 23 May 2012 Accepted 5 June 2012 Online 10 July 2012 Keywords: Cognitive dysfunction Cognitive screening Heart failure Medication nonadherence Veterans abstract Objectives: The study objectives were (a) to describe the prevalence and severity of cognitive impairment (CI) in an outpatient veteran population with heart failure (HF), (b) to describe the cognitive domains affected in those subjects found to have CI, (c) to examine clinical and demographic variables that may be associated with CI, and (d) to determine the relationship between CI and medication adherence (MA). We hypothesized that CI is a prevalent condition in veterans with HF and is associated with poorer MA. Adherence to therapy is essential for successful outcomes. CI may affect adherence; little is known about CI in veterans with HF or the effect of CI on MA. Methods: We enrolled 251 veteran outpatients with HF. Subjects were screened for CI; adherence was determined by pill counts. Subjects with CI underwent further neuropsychologic testing. Results: Unrecognized CI was found in 58% of subjects. Verbal learning, immediate memory, and delayed verbal memory were most impaired. CI was significantly associated with poorer MA. Variables associated with CI included age, African-American race, depression, use of alcohol, and nonparticipation in pill count. Conclusion: Unrecognized CI was prevalent and associated with poorer MA. We propose routine screening for CI in patients with HF. Cite this article: Hawkins, L. A., Kilian, S., Firek, A., Kashner, T. M., Firek, C. J., & Silvet, H. (2012, NOVEMBEReDECEMBER). Cognitive impairment and medication adherence in outpatients with heart failure. Heart & Lung, 41(6), 572-582. http://dx.doi.org/10.1016/j.hrtlng.2012.06.001. Heart failure (HF) is a prevalent, complex, and chronic medical condition that currently affects 5.8 million people in the United States, contributing significantly to increased mortality, morbidity, and healthcare expen- ditures, and decreased quality of life. 1,2 The negative impact of HF on patient outcomes and healthcare costs is projected to escalate as the American population ages and is of particular importance to the Veterans Affairs (VA) health care system, the largest integrated health- care system in the United States. 3,4 Outpatient encoun- ters for HF in the VA system have increased from 550,000 in 2002 to 900,000 in 2009 and represent not only the Funding: Veterans Affairs Chronic Heart Failure Quality Enhancement Research Initiative Pilot Grant RRP-09-166. Authors have no disclosures to report. * Corresponding author: Lee Ann Hawkins, PhD(c), NP, VA Loma Linda Healthcare System, Cardiology Section, 111C, Loma Linda, CA 92357. E-mail address: LeeAnn.Hawkins@va.gov (L. A. Hawkins). 0147-9563/$ - see front matter Published by Elsevier Inc. http://dx.doi.org/10.1016/j.hrtlng.2012.06.001