Cognitive Impairment Linked With Increased Incident Clinical Heart Failure

Independent of cardiac function and other heart failure (HF) risk factors, an association exists between cognitive impairment and increased risk for incident clinical HF, according to study findings published in the Journal of the American Heart Association.

Investigators in Australia examined how the association between cognitive function and HF risk factors, along with cognitive impairment, affects development of incident clinical HF in patients with preclinical HF.

The investigators used data from a prospective cohort recruited in 5 Australian states and included 1966 participants at least aged 18 years with either clinical HF at baseline (recruited consecutively from hospitals) or at risk for HF (recruited from clinics, hospitals, and communities). Patients with moderate or severe primary aortic or mitral valve disease, potentially reversible left ventricular dysfunction, or concomitant terminal noncardiac illness were among those excluded.

Patients with clinical HF (n=1152; mean age, 73 [SD, 13] years), compared with patients with preclinical HF (n=814), were older, more likely to smoke (currently or previously), have poorer cardiac function and greater comorbidities, greater risk of cognitive impairment, and lower MOCA scores (P <.001 for the difference between groups).

The investigators noted that baseline MOCA score was independently associated with HF stage, age, cerebrovascular disease, chronic lung disease, atrial fibrillation, diabetes, left atrial volume index, global longitudinal strain, and left ventricular filling pressure. Among patients with clinical HF, cognitive impairment significantly increased the associations of age (P_interaction <.001), comorbidity index (P_interaction <.001), and global longitudinal strain (P_interaction =.042).

Significant associations in multivariable analysis were noted between worse cognitive impairment and HF stage, age, cerebrovascular disease, chronic lung disease, atrial fibrillation, and diabetes.

Clinical HF occurred in 9% of the patients with baseline preclinical HF, and within the follow-up period of 45 (SD, 13) months, 11% of patients with baseline preclinical HF died.

Compared with individuals with normal cognition and left ventricular function, patients with preclinical HF and either cognitive impairment or left ventricular dysfunction had double the risk of developing clinical HF. Patients with left ventricular dysfunction and concomitant cognitive impairment had 4-fold greater risk of developing HF (sub-distribution hazard ratio, 4.01; 95% CI, 2.39-6.76).

Study limitations include the observational design precluding establishment of causation, and lack of generalizability due to a preponderance of White participants.

“Our findings show that cognitive function is associated with cardiovascular risk factors and might modify the associations of these risk factors with HF and that the presence of cognitive impairment might increase the risk of developing incident clinical HF in people at risk, independent of cardiac systolic dysfunction,” the investigators concluded.

This article originally appeared on The Cardiology Advisor