BACKGROUND: Cognitive impairment (CI) frequently complicates Heart failure (HF) and is associated with increased mortality and morbidity. Previous studies reported that nurse-lead home-based multidisciplinary program (MP) may not improve the prognosis of this high-risk group. In the present study, we analysed the relative effectiveness of an integrated hospital-based MP in patients with cognitive impairment. METHODS: Consecutive (n = 173) community-living outpatients aged > 70 years (mean 77 +/- 6, 48% women) randomized to a MP (n = 86) or usual care (UC) (n = 87) were enrolled in stable clinical conditions. Cognitive status was assessed by means of Folstein Mini Mental State Examination (MMSE). RESULTS: CI (MMSE <= 24) was present in 41.6% (42.5% UC versus 40.7% MP p = NS). The variables independently associated to CI were: older age, education level < 5 years, anemia and severe renal dysfunction. During a 2-year follow-up, 59 patients died (31.4%) with no significant difference between intervention group. At multivariate analysis, in the entire cohort, CI was independently associated to death (HR 2.077 (95%CI 1.097 to 3.931)), HF admissions (2.133 (1.346 to 3.381)), death/HF admissions (1.784 (1.132 to 2.811)) and all-cause admissions (1.473 (1.008 to 2.153). When considered according to intervention groups, CI was independently associated to all-cause death (3.603 (1.553 to 8.358), death/HF admissions (2.029 (1.200 to 3.432)) and HF admissions (2.474 (1.406 to 4.353)) but not to all-cause admissions. The assignment of patients with CI to MP was associated to a significant reduction in HF admissions versus UC (0.503 (0.253 to 0.999) (all interaction tests p = NS). CONCLUSIONS: This study suggests that CI is very common and associated to worse prognosis in heart failure and that hospital-based MP seems to improve outcomes in these patients through reduction of heart failure hospital admission.

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