Neurocognitive, Social-Cognitive and Quality of Life Differences in Children with Advanced Heart Failure: A Single-Center Cross-Sectional Study

BACKGROUND: Children with heart failure (HF) are at risk of cognitive and psychiatric problems, and reduced health-related quality of life (QoL), yet data remain limited. This study compared neurocognition, social cognition, health-related quality of life, and psychiatric symptoms among children awaiting transplantation with or without ventricular assist devices (VADs), those who had undergone heart transplantation, and matched controls. METHODS: Twenty-three patients at Ege University and 17 age- and sex-matched controls were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children, Present and Lifetime Version (K-SADS-PL), Screen for Child Anxiety-Related Emotional Disorders (SCARED), Children's Depression Inventory (CDI), Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV), Eyes Test, and Pediatric Quality of Life Inventory (PedsQL), evaluating psychiatric diagnoses, anxiety and depressive symptoms, cognition, social cognition, and health-related quality of life. RESULTS: Diagnosis rates and CDI and SCARED child scores were comparable, but SCARED parent scores were significantly higher in the HF group. Patients scored significantly lower on most WISC-IV subtests (8 of 10) and all composite scores and the Eyes Test, indicating impaired social cognition. Child- and parent-reported PedsQL scores were significantly lower across all domains. Cognitive outcomes did not differ significantly across treatment subgroups, though these comparisons were underpowered. CONCLUSIONS: Children with HF show marked impairments in neurocognition, social cognition, and health-related quality of life versus healthy peers. Cognitive outcomes did not differ significantly across treatment subgroups, although these subgroup analyses (5-7 children per group) were underpowered and cannot establish the absence of a treatment effect. These findings underscore the need for integrated multidisciplinary care.