TY - JOUR
T1 - Cognitive Change After Cardiac Surgery Versus Cardiac Catheterization
T2 - A Population-Based Study
AU - Whitlock, Elizabeth L.
AU - Diaz-Ramirez, L. Grisell
AU - Smith, Alexander K.
AU - Boscardin, W. John
AU - Avidan, Michael S.
AU - Glymour, M. Maria
N1 - Funding Information:
Funding was provided by the National Institute of General Medical Sciences of the National Institutes of Health grant T32GM008440 (to E.L.W.; Judith Hellman, principal investigator) and by the National Institute on Aging of the National Institutes of Health grant P30GA044281 (to L.G.D.-R., A.K.S., and W.J.B.; Kenneth Covinsky, principal investigator) and grant R03AG059822 (E.L.W., principal investigator). E.L.W. also receives funding from the Foundation for Anesthesia Education and Research. The Health and Retirement Study is sponsored by the National Institute on Aging grant U01AG009740 and conducted by the University of Michigan.
Publisher Copyright:
© 2019 The Society of Thoracic Surgeons
PY - 2019/4
Y1 - 2019/4
N2 - Background: Despite concern that cardiac surgery may adversely affect cognition, little evidence is available from population-based studies using presurgery data. With the use of the Health and Retirement Study, we compared memory change after participant-reported cardiac catheterization or cardiac surgery. Methods: Participants were community-dwelling adults aged 65 years and older who self-reported cardiac catheterization or “heart surgery” at any biennial Health and Retirement Study interview between 2000 and 2014. Participants may have undergone the index procedure any time in the preceding 2 years. We modeled preprocedure to postprocedure change in composite memory score, derived from objective memory testing, using linear mixed effects models. We modeled postprocedure subjective memory decline with logistic regression. To quantify clinical relevance, we used the predicted memory change to estimate impact on ability to manage medications and finances independently. Results: Of 3,105 participants, 1,921 (62%) underwent catheterization and 1,184 (38%) underwent operation. In adjusted analyses, surgery participants had little difference in preprocedure to postprocedure memory change compared with participants undergoing cardiac catheterization (−0.021 memory units; 95% confidence interval: −0.046 to 0.005 memory units, p = 0.12). If the relationship were causal, the point estimate for memory decline would confer an absolute 0.26% or 0.19% decrease in ability to manage finances or medications, respectively, corresponding to 4.6 additional months of cognitive aging. Cardiac surgery was not associated with subjective memory decline (adjusted odds ratio 0.93, 95% confidence interval: 0.74 to 1.18). Conclusions: In this large, population-based cohort, memory declines after heart surgery and cardiac catheterization were similar. These findings suggest intermediate-term population-level adverse cognitive effects of cardiac surgery, if any, are likely subtle.
AB - Background: Despite concern that cardiac surgery may adversely affect cognition, little evidence is available from population-based studies using presurgery data. With the use of the Health and Retirement Study, we compared memory change after participant-reported cardiac catheterization or cardiac surgery. Methods: Participants were community-dwelling adults aged 65 years and older who self-reported cardiac catheterization or “heart surgery” at any biennial Health and Retirement Study interview between 2000 and 2014. Participants may have undergone the index procedure any time in the preceding 2 years. We modeled preprocedure to postprocedure change in composite memory score, derived from objective memory testing, using linear mixed effects models. We modeled postprocedure subjective memory decline with logistic regression. To quantify clinical relevance, we used the predicted memory change to estimate impact on ability to manage medications and finances independently. Results: Of 3,105 participants, 1,921 (62%) underwent catheterization and 1,184 (38%) underwent operation. In adjusted analyses, surgery participants had little difference in preprocedure to postprocedure memory change compared with participants undergoing cardiac catheterization (−0.021 memory units; 95% confidence interval: −0.046 to 0.005 memory units, p = 0.12). If the relationship were causal, the point estimate for memory decline would confer an absolute 0.26% or 0.19% decrease in ability to manage finances or medications, respectively, corresponding to 4.6 additional months of cognitive aging. Cardiac surgery was not associated with subjective memory decline (adjusted odds ratio 0.93, 95% confidence interval: 0.74 to 1.18). Conclusions: In this large, population-based cohort, memory declines after heart surgery and cardiac catheterization were similar. These findings suggest intermediate-term population-level adverse cognitive effects of cardiac surgery, if any, are likely subtle.
UR - http://www.scopus.com/inward/record.url?scp=85063084499&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2018.10.021
DO - 10.1016/j.athoracsur.2018.10.021
M3 - Article
C2 - 30578068
AN - SCOPUS:85063084499
SN - 0003-4975
VL - 107
SP - 1119
EP - 1125
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 4
ER -