Cognitive decline comes sooner for people with heart failure

There are over 6 million Americans with heart failure who are at greater risk of losing their cognitive abilities earlier in life, a study suggests.

The research team, led by Michigan Medicine, examined the cognitive abilities of nearly 30,000 adults over time, comparing those who did and did not develop heart failure.

The researchers found heart failure is associated with a significant decrease in cognition at the time of diagnosis.

Global cognition and executive functioning also declined more rapidly over the years after heart failure diagnosis, as people with the condition mentally aged the equivalent of 10 years within just seven years of a heart failure diagnosis.

The results are published in Circulation: Heart Failure.

“Heart failure 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 Supriya Shore, MBBS, MSCS, first author and clinical assistant professor of internal medicine-cardiology at University of Michigan Medical School.

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

Typical risk factors for cognitive impairment, such as high blood pressure and heart attack, did not explain the accelerated decline observed in the participants with heart failure, according to the study.

The largest decrease in global cognition — a composite of several features of cognitive ability, including attention and problem solving — occurred among older adults, women, and white participants.

Investigators say, based on their findings, that adults with heart failure would reach the threshold for meaningful decline in global cognition nearly six years earlier than people without it.

Executive functioning would diminish around four-and-a-half years earlier.

“Regular cognitive monitoring of older adults with heart failure would help identify individuals with the earliest signs of cognitive decline who require supportive care,” said senior author Deborah A. Levine, M.D., M.P.H., professor of internal medicine and neurology at U-M Medical School. 

“We need a better understanding of the mechanisms driving accelerated cognitive decline after heart failure to develop interventions that halt or slow the decline.”

Decisions about treatment, Shore says, are complex and highly dependent on cognitive capacity.

These findings likely also explain the results of a 2024 qualitative study led by Shore which found that most patients with heart failure displayed a poor understanding of their prognosis.

Caregivers, on the other hand, commonly identified when a patient was declining in health.

Some participants said their physicians avoided these conversations, while others said they were confused by the provider’s medical jargon.

“Most people with heart failure, 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-centered language,” Shore said.

“They want to speak candidly about quality of life and survival assessments. Even though these conversations are tough, people want to have it. 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 heart failure.”

Additional authors: Hanyu Li, M.S., Min Zhang, Ph.D., Rachael Whitney, Ph.D., Brahmajee K. Nallamothu, M.D., M.P.H., Bruno Giordani, Ph.D., Emily M. Briceño, Ph.D., Jeremy B. Sussman, M.D., M.S., all of University of Michigan. See remaining authors online.

Funding/disclosures: This research project is supported by the National Institute of Neurological Disorders and Stroke (R01NS102715) of the National Institutes of Health. The NINDS was not involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication, except that 1 representative (author R.F.G.) of the funding agency reviewed the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NINDS or the NIH. Additional funding was provided to Shore by the American Heart Association (grant ID 855105) and to Levine by the National Institute of Aging (R01AG051827, RF1AG068410)

Paper cited: “Trajectory of Cognitive Function After Incident Heart Failure,” Circulation: Heart Failure. DOI: 10.1161/CIRCHEARTFAILURE.124.011837