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Cognitive Impairment and Heart Failure: Systematic Review and Meta-Analysis
Jane A Cannon1, Peter Moffitt2, Ana Cristina Perez-Moreno1
1Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK.
Insights
Heart failure patients frequently experience cognitive impairment, with a 43% prevalence. This highlights the need for integrated care planning and further research into the causes of cognitive decline in heart failure.
Area of Science:
- Cardiology
- Neurology
- Gerontology
Background:
- Cognitive impairment and dementia are linked to cardiovascular diseases like hypertension and atrial fibrillation.
- Heart failure (HF) is a significant cardiovascular condition with potential neurological implications.
- Existing research suggests an association between HF and cognitive decline, but comprehensive data is limited.
Purpose of the Study:
- To systematically review and synthesize existing literature on the association between heart failure and cognitive impairment/dementia.
- To provide estimates for the prevalence, incidence, and relative risk of cognitive impairment in individuals with heart failure.
- To identify gaps in knowledge regarding the pathophysiology linking heart failure and cognitive dysfunction.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (MEDLINE, EMBASE, CINAHL, PsychINFO, Web of Science, CENTRAL) up to May 2015.
- Studies examining cognitive impairment or dementia in heart failure patients were selected by two independent reviewers.
- Meta-analysis was performed where data permitted, using random-effects models to pool results.
Main Results:
- Out of 18,000 titles, 37 studies (8,411 participants) were included. Data from 4 prospective cohorts indicated greater cognitive decline in HF patients over time.
- Case-control studies (1,414 participants) revealed an odds ratio of 1.67 for cognitive impairment in heart failure patients.
- Prevalence of cognitive impairment in heart failure cohorts (4,176 participants) was estimated at 43% (95% CI: 30-55%).
Conclusions:
- A significant portion of patients with heart failure experience co-occurring cognitive problems.
- These findings have important implications for the planning of treatment strategies and healthcare services for HF patients.
- Further research is required to elucidate the underlying pathophysiology and establish causality between heart failure and cognitive impairment.
Background:
Cognitive impairment and dementia are associated with a range of cardiovascular conditions, including hypertension, coronary artery disease, and atrial fibrillation. We aimed to describe the association with heart failure, summarizing published data to give estimates of prevalence, incidence, and relative risk of cognitive impairment/dementia in heart failure.
Methods:
We searched multidisciplinary databases including MEDLINE (OVID), EMBASE (OVID), CINAHL (EBSCO), PsychINFO (EBSCO), Web of Science (Thomson Reuters), and CENTRAL (Cochrane Library) from inception until May 31, 2015. All relevant studies looking at cognitive impairment/dementia in heart failure were included. Studies were selected by 2 independent reviewers using prespecified inclusion/exclusion criteria. Where data allowed, we performed meta-analysis and pooled results using random effects models.
Results:
From 18,000 titles, 37 studies were eligible (n = 8411 participants). Data from 4 prospective cohorts (n = 2513 participants) suggest greater cognitive decline in heart failure compared with non-heart failure over the longer term. These data were not suitable for meta-analysis. In case control studies describing those with and without heart failure (n = 4 papers, 1414 participants) the odds ratio for cognitive impairment in the heart failure population was 1.67 (95% confidence interval 1.15-2.42). Prevalence of cognitive impairment in heart failure cohorts (n = 26 studies, 4176 participants) was 43% (95% confidence interval 30-55).
Conclusions:
This review suggests a substantial proportion of patients with heart failure have concomitant cognitive problems. This has implications for planning treatment and services. These data do not allow us to comment on causation, and further work is needed to describe the underlying pathophysiology.
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