Cognitive impairment associated with increased mortality rate in patients with heart failure: A systematic review and meta-analysis

Aims We quantified the concurring dynamics affecting total and hippocampal brain volume and cognitive function in patients with chronic heart failure (HF) over a period of three years. Methods and results A total of 148 patients with mild stable HF entered this monocentric prospective cohort study: mean age 64.5 (10.8) years; 16.2% female; 77% in New York Heart Association functional classes I–II; 128 and 105 patients attended follow-up visits after 1 and 3 years, respectively. The assessment included cardiological, neurological, psychological work-up, and brain magnetic resonance imaging. Total and regional brain volumes were quantified using an operator-independent fully automated approach and reported normalized to the mean estimated intracranial volume. At baseline, the mean hippocampal volume was ∼13% lower than expected. However, the 3-year progressive hippocampal volume loss was small: −62 mm3 [95% confidence interval (CI) −81 to −42, P < 0.0001). This corresponded to a relative change of −1.8% (95% CI −2.3 to −1.2), which was similar in magnitude as observed with physiological aging. Moreover, the load of white matter hypointensities increased within the limits of normal aging. Cognitive function during the 3-year observation period remained stable, with ‘intensity of attention’ as the only domain declining (LSmean −1.82 points, 95% CI −3.05 to −0.58, P = 0.004). After 3 years, performance in all domains of cognition remained associated with hippocampal volume (r ≥ 0.29). Conclusion In patients with predominantly mild HF, the markedly reduced hippocampal volume observed at baseline was associated with impaired cognitive function, but no accelerated deterioration in cognition and brain atrophy became evident over a mid-term period of three years.

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“…However, heterogeneous study populations had been included, with different test systems addressing cognitive decline. 18 …”

Section: Discussionmentioning

confidence: 99%

Temporal changes in total and hippocampal brain volume and cognitive function in patients with chronic heart failure—the COGNITION.MATTERS-HF cohort study

Frey

Homola

Henneges

et al. 2021

European Heart Journal

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“…Unfortunately, the healthcare system is commonly built on the assumption that patients comply with healthcare providers' recommendations (83). As cognitive impairment interferes with the ability to follow recommendations, the combination of CI and HF is associated with increased mortality, re-hospitalization [see (92)], and poor quality of life (88).…”

Section: Discussionmentioning

confidence: 99%

Cognition and Frailty in Patients With Heart Failure: A Systematic Review of the Association Between Frailty and Cognitive Impairment

et al. 2021

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Background/Aim: Pathological processes associated with aging increase the risk of cognitive deficits. Frailty syndrome may significantly accelerate these pathological processes in elderly patients with heart failure. The objective of this review was to better understand the association between frailty syndrome and co-occurring cognitive decline in patients with heart failure.Methods: We conducted a systematic review based on PubMed/MEDLINE, Scopus, EMBASE, and CINAHL as databases. The search followed the method described by Webb and Roe. For inclusions, the studies were selected employing cross-sectional and longitudinal designs. The included studies had to evaluate frailty syndrome and cognitive impairments among participants with heart failure. As we were interested in older adults, the search was limited to individuals >65 years of age. The search was limited to primary research articles written in English published since the year 2000.Results: Of the 1,245 studies retrieved by the systematic review, 8 relevant studies were enclosed for the full-text review. Our review revealed that most studies of patients with HF demonstrated evidence of an association between greater frailty and cognitive impairment. In particular, six studies reported evidence for the significant association between higher levels of frailty and cognitive impairment in patients with heart failure. The remaining two studies failed to find an association between frailty and cognitive impairment.Conclusions: The development of frailty and cognitive impairment in heart failure is particularly important because this cardiovascular disease is a common cause of both morbidity and mortality in the world. The results of this review fill the existing gap in the literature related to the identification of clinical factors linked with frailty syndrome that contribute to cognitive impairment in patients with a diagnosis of heart failure. The prevalence of overlapping frailty and cognitive impairment in patients with heart failure, therefore, necessitates a routine assessment of these components in the care of patients with cardiovascular disease.

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“…Indeed, in a recent systematic review and metaanalysis, the odds ratio for cognitive impairment in the CHF population in case-control studies was 1.67 [95% confidence interval (CI) 1.15-2.42] and the prevalence of cognitive impairment in CHF cohorts (n = 26 studies, 4176 participants) was 43% (95% CI 30-55) [8]. The presence of cognitive impairment has a great impact on CHF patients' health status as it contributes to low self-care, poor adherence to clinical prescriptions, increased re-hospitalizations and higher risk of mortality [9][10][11]. In particular, poorer global cognitive score and working memory, psychomotor speed, and executive function dysfunctions are significant predictors of mortality [12].…”

Section: Introductionmentioning

confidence: 99%

Psychomotor speed as a predictor of functional status in older chronic heart failure (CHF) patients attending cardiac rehabilitation

et al. 2020

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Background The association among psychological, neuropsychological dysfunctions and functional/clinical variables in Chronic Heart Failure (CHF) has been extensively addressed in literature. However, only a few studies investigated those associations in the older population. Purpose To evaluate the psychological/neuropsychological profile of older CHF patients, to explore the interrelation with clinical/functional variables and to identify potential independent predictors of patients' functional status. Methods This study was conducted with a multi-center observational design. The following assessments were performed:

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Cognitive impairment associated with increased mortality rate in patients with heart failure: A systematic review and meta-analysis

Cited by 29 publications

References 37 publications

Temporal changes in total and hippocampal brain volume and cognitive function in patients with chronic heart failure—the COGNITION.MATTERS-HF cohort study

Temporal changes in total and hippocampal brain volume and cognitive function in patients with chronic heart failure—the COGNITION.MATTERS-HF cohort study

Cognition and Frailty in Patients With Heart Failure: A Systematic Review of the Association Between Frailty and Cognitive Impairment

Psychomotor speed as a predictor of functional status in older chronic heart failure (CHF) patients attending cardiac rehabilitation

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