Cognitive impairment is associated with lower physical function in patients with heart failure

Introduction Cognitive impairment is a common and serious comorbidity in patients with heart failure (HF) and its prevalence follows the severity of the condition. Preventing deterioration in patients with heart failure is key to improve outcomes. Cognitive impairment might be correlated to physical function. Purpose To assess cognitive impairment in patients with HF and exploring its potential association with physical function. Methods Data was collected in 246 patients with HF (mean age 68±10, 28% female). Cognition was measured with the Montreal Cognitive Assessment (MoCA). Physical function was measured with an activity monitor – Actigraph (minutes/day spent in sedentary time, light physical activity and moderate to vigorous physical activity (MVPA) as well as steps daily), exercise capacity (6-minute walk test), self-selected walking speed (gait speed for 10 meters in seconds) and the dynamic balance/mobility (Sit-to-stand test: number in 30 seconds). Difference in physical function between patients who have mild to moderate cognitive impairment (MoCA cut off value 26) were compared to patients who had no to light cognitive impairment (MoCA Cut off value ³27) with Mann-Whitney U tests. Results A total of 246 patients with HF were evaluated, 171 patients (70%) had mild cognitive impairment and 3 patients (1%) had moderate cognitive impairment. Patients with mild or moderate cognitive impairment, were older (mean 69 vs. 63 years old, p-value<.001) and with diverse comorbidities, as they suffered more often from COPD (18% vs 7%, p-value=0.015) and stroke (15% vs. 6%, p-value 0.028) compared to patients with no to light cognitive impairment. Patients with mild or moderate cognitive impairment spent more time sedentary (median 562 vs. 530 min/day, p-value=0.029), less time in MVPA (median 10 vs. 21 min/day, p-value=0.003) compared to patients with no to light cognitive impairment and walked less steps a day (median 3884 vs. 5206, p-value=0.002). No differences were found in spent time in light physical activity (206 vs 226 min/day p-value=0.65). Patients with mild or moderate cognitive impairment walked a lower number of meters on the 6MWT (median 438 vs. 528 meters, p-value=<.001), were slower on gait speed (median 6 vs. 5 seconds, p-value<.001) and on the sit-to-stand test (median 11 vs. 9 times, p-value<.001) compared to patients with no to light cognitive impairment. Conclusion 71% of patients with heart failure had mild or moderate cognitive impairment, which was negative associated with physical function. Screening for cognitive impairment together with physical function may decrease adverse events by identifying those who need tailored care.