Effects of Cardiac Rehabilitation on Cognitive Function in Heart Failure: A Systematic Review and Meta-Analysis

Cognitive impairment frequently complicates heart failure (HF) and is linked to poor self-care, reduced treatment adherence, and worse clinical outcomes. Cardiac rehabilitation (CR), centered on structured exercise training, may improve cognitive function, but current evidence is inconsistent. We systematically evaluated the effects of CR on cognitive function in patients with HF.

A systematic search was conducted to identify randomized controlled trials and observational studies assessing cognitive outcomes in HF patients undergoing CR. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were used and heterogeneity was assessed using the I² statistic. Prespecified and exploratory subgroup analyses were conducted to explore potential sources of heterogeneity. The primary outcome was the change in global cognitive function.

Eleven studies involving 1,580 participants were included in the systematic review. Ten were eligible for quantitative analyses. Two pre-post CR studies (n=66) showed improved cognitive scores following CR (SMD=0.56; 95% CI, 0.21-0.91; p=0.002). In 6 CR versus non-CR studies (n=876), CR was associated with improved cognition (SMD=0.53; 95% CI, 0.09-0.97; p=0.02), with substantial heterogeneity (I²=83%). Sensitivity analyses suggested heterogeneity was influenced by methodological quality. Exploratory analyses indicated cognitive benefit was more apparent in stable chronic HF and among patients with baseline cognitive impairment. Three studies (n=190) found no significant additional benefit from beyond adjunctive therapies beyond standard CR (SMD=-0.26, 95% CI, -1.43-0.91, p=0.67).

CR is associated with improvements in global cognitive function in patients with HF and may contribute to both physical and cognitive health in HF management.