Cognitive Impairment in Acute Heart Failure: Narrative Review
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Published on: June 10, 2025
Ioannis Ventoulis1, Angelos Arfaras-Melainis2,3, John Parissis2
1Department of Occupational Therapy, University of Western Macedonia, 50200 Ptolemaida, Greece.
Insights
Cognitive impairment is a common issue in acute heart failure (AHF) patients, impacting quality of life and outcomes. More research and screening guidelines are needed for this under-recognized condition.
Area of Science:
- Cardiology
- Neurology
- Gerontology
Background:
- Cognitive impairment (CI) is a frequent, often undetected comorbidity in acute heart failure (AHF).
- CI in AHF presents as a spectrum of deficits, from mild to severe neurocognitive disorder.
- CI significantly worsens quality of life and is linked to adverse outcomes in AHF patients.
Purpose of the Study:
- To review the current understanding of cognitive impairment in acute heart failure.
- To highlight the need for standardized cognitive screening guidelines in heart failure (HF) patients.
- To explore the multifactorial pathophysiological mechanisms of CI in AHF.
Main Methods:
- This is a narrative review.
- Literature search on cognitive impairment in acute heart failure.
- Synthesis of existing evidence on CI pathophysiology and clinical implications in AHF.
Main Results:
- CI is prevalent in AHF, affecting various cognitive domains.
- Pathophysiological mechanisms are complex and multifactorial, varying with AHF phenotype.
- Cognitive decline is associated with both chronic HF and acute exacerbations.
Conclusions:
- CI in AHF is under-recognized and requires greater clinical attention.
- There is a critical need for consensus guidelines on cognitive screening in HF.
- Further research is essential to address unresolved issues concerning CI in hospitalized AHF patients.
Abstract:
Cognitive impairment (CI) represents a common but often veiled comorbidity in patients with acute heart failure (AHF) that deserves more clinical attention. In the AHF setting, it manifests as varying degrees of deficits in one or more cognitive domains across a wide spectrum ranging from mild CI to severe global neurocognitive disorder. On the basis of the significant negative implications of CI on quality of life and its overwhelming association with poor outcomes, there is a compelling need for establishment of detailed consensus guidelines on cognitive screening methods to be systematically implemented in the population of patients with heart failure (HF). Since limited attention has been drawn exclusively on the field of CI in AHF thus far, the present narrative review aims to shed further light on the topic. The underlying pathophysiological mechanisms of CI in AHF remain poorly understood and seem to be multifactorial. Different pathophysiological pathways may come into play, depending on the clinical phenotype of AHF. There is some evidence that cognitive decline closely follows the perturbations incurred across the long-term disease trajectory of HF, both along the time course of stable chronic HF as well as during episodes of HF exacerbation. CI in AHF remains a rather under recognized scientific field that poses many challenges, since there are still many unresolved issues regarding cognitive changes in patients hospitalized with AHF that need to be thoroughly addressed.
