UTSW researchers followed shock survivors after hospital discharge and found high rates of cognitive impairment, suggesting need for screening, referrals to aid recovery
Many survivors of cardiogenic shock showed evidence of new cognitive impairment after leaving the hospital, according to a study led by UT Southwestern Medical Center researchers. The findings, published in the Journal of the American College of Cardiology, highlight a need to screen survivors and provide referrals to neuropsychology experts, the authors said.
James de Lemos, M.D., Professor of Internal Medicine and Chief of the Division of Cardiology at UT Southwestern, was the study's senior investigator. He holds the Sweetheart Ball - Kern Wildenthal, M.D., Ph.D. Distinguished Chair in Cardiology.
“Our study demonstrated that nearly two-thirds of cardiogenic shock survivors experienced cognitive impairment within three months of hospital discharge, underscoring a critical but overlooked aspect of recovery,” said senior investigator James de Lemos, M.D., Professor of Internal Medicine and Chief of the Division of Cardiology at UT Southwestern. “The findings are important for developing interventions that focus not only on improving survival but also on preventing or mitigating the functional consequences of cardiogenic shock, including cognitive decline.”
Cardiogenic shock affects approximately 100,000 Americans each year, resulting from heart failure, heart attack, or complications following cardiac surgery. The condition, which occurs when the heart is unable to pump enough blood to meet the body’s needs, has historically resulted in high mortality.
With advances in treatment during the past two decades, up to 70% of patients suffering from cardiogenic shock can now survive. But there is limited understanding of survivors’ recovery and quality of life after they leave the hospital.
“Our study is the first to systematically examine the cognitive outcomes of cardiogenic shock survivors, evaluating how cognition impacts patients’ ability to return to daily activities,” said Eric Hall, M.D., a clinical fellow in the Division of Cardiology who was the study leader and first author. “We found that cardiogenic shock is associated with cognitive impairment, which is an under-recognized consequence strongly linked to patients’ overall quality of life.”
Eric Hall, M.D., clinical fellow in the Division of Cardiology at UT Southwestern, was the study leader and first author.
UTSW researchers conducted the study by enrolling 141 patients from William P. Clements Jr. University Hospital and Parkland Memorial Hospital who had survived cardiogenic shock before being discharged. To establish a baseline, family members completed a questionnaire, the AD8 survey, about the patients’ cognitive function before hospitalization.
Before discharge, each patient completed an assessment, the Montreal Cognitive Assessment-Blind (bMoCA), to screen for signs of cognitive impairment. Three months after discharge, patients repeated the assessments, allowing researchers to track changes in thinking ability and daily functioning over time.
Among patients with no sign of cognitive impairment before admission, 65% were found to have new impairment at discharge, and 53% continued to show impairment at their three-month follow-up. UTSW researchers emphasized that these findings should inform the development of comprehensive survivorship programs including screening protocols to identify impairments patients face and rehabilitation programs to help them recover from those challenges.
“We hope to use this study as a foundation to develop targeted rehabilitation strategies that connect patients with neuropsychology experts and improve long-term recovery in cardiogenic shock survivors,” Dr. de Lemos said.
Other UTSW researchers who contributed to the study are Maryjane Farr, M.D., Professor of Internal Medicine in the Division of Cardiology; C. Munro Cullum, Ph.D., Professor of Psychiatry, Neurological Surgery, and Neurology; Jeff Schaffert, Ph.D., Assistant Professor of Psychiatry; Laura Lacritz, Ph.D., Professor of Psychiatry and Neurology; Amil Shah, M.D., Professor of Internal Medicine in the Division of Cardiology; Colby Ayers, M.S., Faculty Associate, Division of Cardiology; and Alexandra Sykes, M.D., Cardiology Fellow. Dr. Cullum is an Investigator in the Peter O’Donnell Jr. Brain Institute.
Dr. de Lemos holds the Sweetheart Ball - Kern Wildenthal, M.D., Ph.D. Distinguished Chair in Cardiology.
The study was funded by a National Heart, Lung, and Blood Institute T32 training grant (5T32HL12524). Dr. Cullum has served as Scientific Director of the Texas Alzheimer’s Research and Care Consortium (TARCC).