Trajectories of Cognitive Function, Affective Symptoms, and Self-Care in Heart Failure

OBJECTIVE: In this prospective cohort analysis, we examined 12-month trajectories of cognitive function, affective symptoms, and self-care in older adults with heart failure (HF) and evaluated whether baseline frailty modified these changes. METHODS: In this prospective cohort study, 124 adults aged ≥60 years hospitalized for acute HF were assessed at baseline and at 6 and 12 months. Cognitive function was measured using the Mini-Mental State Examination (MMSE), affective symptoms using the Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire-9 (PHQ-9), and self-care using the European Heart Failure Self-Care Behavior Scale (EHFSc-9). Longitudinal changes were analyzed using the Friedman test with post hoc Wilcoxon tests. Baseline frailty groups were compared using the Mann-Whitney U test. Exploratory correlations were evaluated using Spearman coefficients and were not corrected for multiple testing. RESULTS: Cognitive performance declined significantly over 12 months (MMSE: 28.13 ± 1.69 to 26.14 ± 1.67; P = .001). Depressive symptoms increased over time (HADS-D: 2.72 ± 3.44 to 3.88 ± 3.97, P = .001; PHQ-9: 5.48 ± 4.82 to 6.44 ± 4.92, P < .001), while anxiety showed a modest increase (P = .003). Self-care scores remained stable (P = .151). Baseline frailty did not significantly influence the trajectory of affective symptoms or self-care. In exploratory, unadjusted analyses, depressive symptoms were correlated with self-care scores among patients with HF with preserved ejection fraction (PHQ-9 vs. EHFSc-9: r = -0.369, P = .019). Greater depressive burden was correlated with lower MMSE scores at 6 months (r = -0.161, P = .041). CONCLUSIONS: Older adults with HF demonstrated progressive cognitive decline and worsening affective symptoms over 12 months, whereas self-care remained relatively stable. Baseline frailty was not associated with any differential longitudinal changes. Exploratory correlations should be interpreted as hypothesis-generating.