Cognitive impairment and evolution of heart failure: a heart-brain interconnection

Aims While many studies have suggested that heart failure (HF) may lead to cognitive impairment (CI), our understanding about this relationship is limited. This study investigated the association of cognitive function with HF risk factors and how CI may impact the development of incident clinical HF in people with subclinical HF. Methods and Results People with either preclinical (at risk and asymptomatic, n=814) or clinical HF (symptomatic, n=1152) were recruited from communities, clinics, and hospitals in five Australian States (Victoria, New South Wales, South Australia, Tasmania, and Queensland). CI was measured with Montreal Cognitive Assessment (MOCA <26). Left ventricular dysfunction (LVD) was assessed as global longitudinal strain (GLS <16%). Those with preclinical HF were followed-up for 45±13 months for incident clinical HF or death. Baseline MOCA was independently associated with age, HF stage, diabetes, atrial fibrillation, chronic lung disease, cerebrovascular disease, GLS, left atrial volume index, and left ventricular filling pressure. CI significantly increased the associations of age (interaction p<0.001), comorbidity index (interaction<0.001), and GLS (interaction p=0.042) with clinical HF. Of those with preclinical HF at baseline, 71 (9%) developed clinical HF and 87 (11%) died within the follow-up period. In time-to-event analysis of participants with preclinical HF, those with either CI or LVD had double the risk of developing clinical HF, compared with those with normal cognition and LV function. Those with concomitant CI and LVD had a 4-fold greater risk of developing HF (SHR=4.01 [95% CI: 2.39-6.76]). Conclusions CI is associated with increased risk of incident clinical HF, independent of cardiac function and other HF risk factors.