Cognitive impairment among heart failure patients: How cardiologists can help
Signs of cognitive impairment are common among heart failure patients, according to a new scientific statement from the Heart Failure Society of America (HFSA). This can have a direct impact on how patients function, the group noted, causing them to mismanage their medications and struggle to take care of themselves.
The full statement is available in full in the Journal of Cardiac Failure.[1]
“Cognitive impairment is not the exception; it’s the norm for our patients with heart failure,” said co-lead author Eiran Z. Gorodeski, MD, MPH, a cardiologist with University Hospitals and Case Western Reserve University School of Medicine, said in a statement. “We as clinicians must invest the extra effort to identify it, and then adjust management accordingly.”
According to Gorodeski et al., the cognitive impairment rate among some subsets of heart failure patients could be as high as 78%. This can affect a person’s learning and memory skills, their ability to communicate and much more. The HFSA statement emphasizes just how harmful this can be for heart failure patients, making it harder to take prescribed medications as recommended, for example, or read food labels.
Another key takeaway from the statement is the fact that preexisting cardiovascular issues can increase a patient’s risk of cognitive impairment. Heart patients already battling atrial fibrillation or hypertension, for example, may already face an uphill battle due to these ongoing issues.
Aging is another risk factor that clinicians must keep in mind. Even “normal aging processes contribute to the structural and chemical changes responsible for cognitive impairment,” the authors wrote. As the U.S. population continues to age, this suggests the number of heart failure patients living with cognitive impairment could increase in the year ahead.
How to identify, help heart failure patients showing signs of cognitive impairment
The statement’s authors highlighted ways that healthcare teams can identify heart failure patients who may be experiencing different symptoms of cognitive impairment. The first way to find these patients is perhaps the most straightforward and requires no additional technology: pay close attention to how they act and communicate.
“Gaps and/or errors in patients’ self-reported histories of present illness could be indicative of short-term memory loss and related cognitive impairment,” the authors wrote. “Missed doses and/or medication errors could be indicative of cognitive impairment; nonadherence may not always represent an explicit unwillingness to or disinterest in taking medications according to instructions and may, in fact, be inadvertent due to impairments in cognition. Limited health literacy (especially if a decline is noted over time) may be a clue to cognitive impairment. Finally, new deficits in instrumental activities of daily living (manifested as increased dependence on others for assistance with various tasks such as managing finances) could indicate cognitive impairment.”
Clinicians who pick up on any of these signals should investigate the situation further, according to the group. Several “formal screening tools” also exist that can help identify patients with cognitive impairment. These include the Mini-Cog test, Mini-Mental State Exam, Montreal Cognitive Assessment and Saint Louis University Mental Status Examination.
“If cognitive impairment is suspected, it may be reasonable to refer to a specialist for imaging and neuropsychological testing, which can provide a definitive diagnosis and characterization,” the authors wrote. “Neuropsychological testing usually examines multiple domains, including intelligence, memory, language, executive function, and visuospatial function; it is administered by specialized neuropsychologists and can last up to two–four hours.”
Managing a patient’s medications—including deprescribing, in some cases—is one way clinicians can work to help heart failure patients who show signs of cognitive decline. Suggesting exercise and engaging the patient’s friends and family are other ways to help ensure the patient is receiving the best care possible and living a fulfilling life.
Click here to read the full scientific statement in Journal of Cardiac Failure.
“A core priority for HFSA is to improve heart failure care,” HFSA President James C. Fang, MD, said in the organization’s statement. “Thanks to the work done by the co-authors of this HFSA scientific statement, cognitive impairment has been highlighted as a big part of the overall holistic care for patients living with heart failure. Increasing our attention to this important co-morbidity will ensure our patients receive comprehensive care."
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.