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Published on: January 11, 2020
Practices and barriers in screening for cognitive impairment in heart failure: a clinician survey
Sotiria Liori1, Chris Kapelios1, Kalliopi Keramida2
1Heart Failure Unit, Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens School of Medicine, Rimini 1, Athens 12462, Greece.
Insights
Cardiologists are aware of cognitive impairment (CI) in heart failure (HF) patients but rarely screen for it due to time constraints. Increased knowledge and support for routine screening correlate with higher screening frequency.
Area of Science:
- Cardiology
- Neurology
- Healthcare Management
Background:
- Cognitive impairment (CI) is prevalent in heart failure (HF) patients, negatively impacting adherence and outcomes.
- Routine cognitive assessment in HF patients remains underutilized in clinical practice.
Purpose of the Study:
- To assess current cognitive assessment practices among cardiologists managing HF patients.
- To identify barriers to cognitive screening and evaluate associations between clinician knowledge, attitudes, and behaviors.
- To explore the gap between awareness and implementation of CI screening in HF care.
Main Methods:
- A cross-sectional survey was administered to 120 cardiologists within the Hellenic Heart Failure Clinics Network.
- The survey included 13 questions on knowledge, attitudes, screening methods, and barriers related to CI in HF.
- Data were analyzed using Pearson's chi-square to examine associations between variables.
Main Results:
- A 42.5% response rate (51 cardiologists) was achieved, with 80% aware of CI prevalence but only 14% systematically screening.
- Key barriers identified were lack of time (76%) and unfamiliarity with assessment tools (50%).
- Significant positive correlations were found between CI knowledge and screening frequency, screening frequency and support for routine practice, and screening frequency and specialist referral.
Conclusions:
- A significant gap exists between awareness of CI in HF patients and its systematic screening.
- Clinician patient load did not influence screening frequency; time and tool familiarity are primary barriers.
- Integrating screening tools and establishing clear referral pathways, coupled with education, can address the evidence-practice gap in CI management for HF patients.
Background:
Cognitive impairment (CI) affects a significant percentage of heart failure (HF) patients, reducing adherence and worsening outcomes. Routine cognitive assessment remains limited.
Objectives:
To evaluate cognitive assessment practices, identify barriers, and examine associations between knowledge, attitudes, and clinical behaviours among clinicians managing HF patients.
Methods:
An anonymous cross-sectional survey was distributed to 120 cardiologists across 68 clinics in the Hellenic Heart Failure Clinics Network (May-June 2025). The 13-question survey examined knowledge on cognitive decline, personal opinions on screening, assessment methods, and implementation obstacles. Associations were examined using Pearson's chi-square.
Results:
Fifty-one cardiologists completed the survey, corresponding to a response rate of 42.5%. Among respondents 80% reported awareness of the high prevalence of cognitive decline, 14% systematically screened for CI presence. Main barriers reported were lack of time (76%) and inadequate familiarity with assessment tools (50%). Screening frequency was not associated with HF patient volume (χ2 = 4.75, P = .58). Significant correlations were demonstrated between (i) knowledge on CI and frequency of screening (V = 0.37, P = .04); (ii) frequency of screening and support of establishing screening as routine practice (V = 0.50, P < .001); and (iii) frequency of screening and referral of patients to specialists (V = 0.39, P = .007). All respondents expressed interest in further education.
Conclusion:
There is a gap between awareness of and testing for CI in HF patients, with the latter not being affected by clinicians' patient load. Since there is universal interest in learning, integrating screening tools into daily routines and creating clear referral pathways may help in addressing this evidence-practice gap.
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