Key result
Incident heart failure linked to ~0.3-point higher 1-year absolute dementia risk vs matched controls.
Why the study?
Heart failure has been linked to dementia through potential mechanisms like cerebral hypoperfusion and neurohormonal dysregulation, motivating an assessment of the risk of dementia together with the competing risk of mortality in patients with HF.
Does incident heart failure increase the risk of incident all-cause dementia and mortality compared with matched controls without heart failure?
Cohort (n=541,477)
Yes
Does incident heart failure increase the risk of incident all-cause dementia and mortality compared with matched controls without heart failure?
Incident heart failure is associated with an increased 1-year absolute risk of dementia, particularly in younger patients, whereas in patients aged 80 and older, the high competing risk of mortality lowers the observed absolute dementia risk below that of controls.
Incident HF was associated with modestly higher 1-year dementia risk, especially younger patients; extends observational links but leaves open causality and should not change practice.
Background and purpose Heart failure (HF) has been linked to dementia, potentially through mechanisms such as cerebral hypoperfusion and neurohormonal dysregulation. Here we assess the risk of dementia together with the risk of mortality in patients with HF. Method Using nationwide Danish registries, we identified all patients with new-onset HF without a diagnosis of dementia between 1999 and 2023. Patients were matched on year of inclusion, sex and birth year in a 1:2 ratio, with individuals without HF and dementia. The primary outcome of interest was incident dementia (all-cause), and the secondary outcome included all-cause mortality. Age-stratified absolute risks of dementia and mortality were estimated for patients with HF and their matched controls. Results In total 180,501 patients with incident HF and 360,976 controls were included, with a median age of 74 years (IQR: 65-82) and 61% being males. During the study period, the overall absolute 1-year risk of dementia was higher in patients with HF compared with controls 1.29% (95% confidence interval (CI: 1.24-1.34)) versus 1.03% (0.9-1.06)), accounting for the competing risk of death. In patients with HF aged 60 years, the absolute risk of dementia during this studyperiod was 2.13% (0.00-5.16) together with a risk of mortality of 70.3% (65.0-75.2), compared to patients without HF where the risks were 0.44% (95% CI: 0.32-0.55) and 6.99% (6.41-7.57), respectively. From age 80, the absolute risk of dementia became higher in controls than for patients with HF, likely due to the substantial competing risk of death in HF (Figure 1). Conclusion Overall, incident HF was associated with a higher 1-year absolute risk of dementia compared with matched controls. The association was modified by age, with higher dementia risk in HF at younger ages but an apparent crossover at older ages, most likely driven by the substantial competing risk of mortality in HF.stacked risk by age
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Blenkov et al. (2026) conducted a cohort in New-onset heart failure without prior dementia (n=541,477). New-onset heart failure vs. Matched individuals without heart failure and dementia was evaluated on Incident dementia (all-cause). Incident heart failure was associated with a higher 1-year absolute risk of dementia compared with matched controls (1.29% vs 1.03%), though risk crossed over after age 80 due to competing mortality.
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