A new study from Emory University found a combined therapy of brain training and aerobic exercise improved multiple measures that drive better health outcomes and lower costs in patients with heart failure. The brain training used in the study was the BrainHQ app from Posit Science.
An estimated 6.5 million Americans are diagnosed with heart failure, with 960,000 new cases each year. Among older adults, it’s the most common cause of readmissions within 30 days of hospital discharge and among the most costly Medicare expenditures.
Cognitive impairment is common among people with heart failure, which can have a devastating effect on patient abilities to engage in self-care, and which contributes to adverse clinical outcomes, increased rehospitalizations, and higher mortality rates.
In this study, the patients had a mean cognitive score on the Montreal Cognitive Assessment (MoCA) of 21, with a range of 13-26. This is indicative of cognitive impairment. According to the MoCA website, the average score for Mild Cognitive Impairment is 22, and for Alzheimer’s Disease is 16. On average, participants were aged 61, female (54%), and African American (55%). Most studies in heart failure have been among white men.
Researchers randomized 69 patients into three groups: a Control group that engaged in a stretching and flexibility program; an Exercise intervention group that was asked to walk 30-45 minutes at moderate intensity three times per week for 12 weeks; and a Combined Training intervention group that was asked to do the same walking regimen, plus 60 minutes of BrainHQ exercises three times per week for 12 weeks.
The researchers reported on the impact of the interventions on measures of patient self-care abilities, quality of life, and physical function. A prior report from these researchers found improved verbal memory in the Combined Training group, with no significant gains in the Exercise or Control groups.
The researchers evaluated patient outcomes using parts of the Self-Care of Heart Failure Index. Only the Combined Training group had significant improvement on the self-management subscale, while the Control group experienced significant decline and the Exercise group was not significantly different from the control. Researchers also found a clinically meaningful increase in the self-care maintenance subscale only in the Combined Training group, with no change in the Exercise group, and a small but not meaningful gain in the Control group.
The researchers measured quality of life using the Kansas City Cardiomyopathy Questionnaire, a disease-specific index for heart failure. Only the Combined Training group had a significant improvement on the subscale for physical abilities, while the Control group experienced significant decline and the Exercise group did not significantly differ from the control.
The 6-Minute Walk Test is a simple assessment used in heart failure that’s predictive of future health outcomes. Scores of 300 meters or less are associated with higher disease burden, higher hospitalization rates, and mortality. A change of 50 meters is clinically significant. These participants were on the cusp of high risk, with an average baseline score of about 340 meters. The Combined Training group had a clinically significant improvement of 50 meters; the Exercise group had an improvement that was not clinically significant of 3 meters, and the Control group had a decline of 13 meters.
“These are exciting results,” observed Dr. Henry Mahncke, CEO of Posit Science, whose brain training was used in this independent study. “As these researchers have shown, the ability to improve measures of cognition, self-care capabilities, quality of life, and physical function in heart failure patients — who are known to face a challenging prognosis with high Medicare costs — should be of interest to providers and insurers. We will certainly be sharing these results with the Medicare Advantage plans that already provide BrainHQ, as well as with other interested in better health outcomes and cost savings.”
In prior studies of BrainHQ among heart failure patients, researchers found significant gains in global cognition, processing speed, verbal memory, and learning, as well as significant gains that showed re-normalized BDNF (a blood marker of brain health). A study at Indiana University reported a trend toward reducing healthcare costs by half, driven largely by reduced rehospitalizations.