Heart failure precedes rapid, sustained cognitive decline

A rapid and persistent deterioration in cognitive function appears to occur following the onset of heart failure (HF), as reported in a study.

In a US cohort of 29,614 adults (mean age 61 years, 55 percent female, 70 percent White), initial reductions in global cognition (−1.1 points, 95 percent confidence interval [CI], −1.4 to −0.8) and executive function (−0.6 points, 95 percent CI, −1.0 to −0.3) scores were observed among those who received a diagnosis of HF. [Circ Heart Fail 2025;doi:10.1161/CIRCHEARTFAILURE.124.011837]

Over a median follow-up of 6.6 years, individuals with incident HF showed a progressive decline in cognitive function, with global cognition decreasing by 0.1 points annually (95 percent CI, −0.2 to −0.1) and executive function by 0.2 points annually (95 percent CI, −0.2 to −0.1). This means the time to meaningful decline would occur sooner by about 6 years for global cognition and by 4.5 years for executive function, the authors said.

They also noted that the decline in global cognition and executive functioning caused the individuals to experience a mental ageing equivalent to 10 years within just nearly 7 years of a HF diagnosis.

Meanwhile, memory exhibited a nonsignificant downward trajectory, starting with a 0.5-point decrease (95 percent CI, −1.4 to 0.3) and continuing with a yearly reduction of 0.1 points (95 percent CI, −0.3 to 0.0).

Older adults, women, and White individuals showed larger decreases in global cognition. Known risk factors for cognitive decline, such as hypertension and heart attack, could not account for the accelerated cognitive deterioration.

“HF is a disease that never goes away and treating it relies heavily on a patient’s ability to follow specific instructions, monitor their symptoms and keep up with many different medications,” said first study author Dr Supriya Shore from the University of Michigan Medical School in Ann Arbor, Michigan, US.

“Seeing this cognitive decline among patients, and how it worsens over time after a diagnosis of HF, should be a warning for providers to assess a patient’s cognitive ability early and factor it into the care plan,” Shore continued.

Poor prognosis comprehension

The findings presented in this study provide a potential explanation for the real-world-observations made in a 2024 qualitative study also led by Shore. In semistructured interviews conducted with seven patient–care partner pairs, patients with HF demonstrated a poor understanding of their prognosis. In contrast, the care partners were more attuned to the patients’ declining health. [Circ Cardiovasc Qual Outcomes 2024;17:e010662]

Patients and their care partners identified similar barriers to prognostic understanding, such as conversation avoidance by physicians, information inconsistency across physicians, distractions during prognosis communication due to emphasis on other medical conditions, and confusion related to the use of medical jargon.

“Most people with HF, as well as their care partners, want discussions around prognosis to begin early in the course of the disease and to be repeated routinely using patient-centred language. They want to speak candidly about quality of life and survival assessments. Even though these conversations are tough, people want to have it,” Shore said.

“With what we know about the rate of cognitive decline in this patient population, there is a major need to meet patients where they are with clarity and compassion to improve overall care in HF,” she added.