Heart Failure Tied to Rapid Decline in Thinking Skills, Attention, and Memory: Study

Researchers from the University of Michigan, US, examined the cognitive abilities of nearly 30,000 adults over time, comparing those who did and did not develop heart failure.

They found that heart failure is associated with a significant decrease in cognition at the time of diagnosis. Global cognition and executive functioning also declined more rapidly in the years after diagnosis. People with the condition mentally aged the equivalent of ten years within just seven years of a heart failure diagnosis, the researchers said.

“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 Dr Supriya Shore, MBBS, MSCS, first author and clinical assistant professor of internal medicine cardiology at the 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,” she added.

Notably, the study, published in the journal Circulation: Heart Failure, showed that typical risk factors for cognitive impairment, such as high blood pressure and heart attack, did not explain the accelerated decline observed in participants with heart failure.

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.

Researchers noted that adults with heart failure reached the threshold for meaningful decline in global cognition nearly six years earlier than people without it. Executive functioning declined 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 Dr Deborah A. Levine, MD, MPH, senior author and professor of internal medicine and neurology at the University of Michigan 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.”

Shore said decisions about treatment are complex and highly dependent on cognitive capacity. The findings also help 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,” Dr Shore said. “They want to speak candidly about quality of life and survival assessments. Even though these conversations are tough, people want to have them. 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.”