Heart Failure Triggers Early Cognitive Decline
Heart failure accelerates cognitive decline, with patients aging mentally by 10 years within 7 years of diagnosis.
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A new study published in Circulation: Heart Failure highlights the link between heart failure and early cognitive decline. The research, led by Michigan Medicine, analyzed the cognitive abilities of nearly 30,000 adults over several years, comparing those with and without heart failure.
Cognitive decline
The gradual loss of mental abilities, such as memory, attention and problem-solving. It can occur naturally with aging or be accelerated by conditions like heart failure.
Impact of heart failure on cognition
The study found that individuals diagnosed with heart failure experienced a decrease in cognitive function at the time of diagnosis. Over the following years, cognitive decline in these individuals accelerated, with those affected by heart failure mentally aging the equivalent of 10 years within just 7 years of their diagnosis. Both global cognition and executive functioning were notably affected.
Executive functioning
A set of cognitive processes that help individuals plan, make decisions, solve problems, and control their behavior. This function is often affected in aging and neurological conditions.
Early cognitive decline in heart failure patients
Dr. Supriya Shore, MBBS, MSCS, the study’s first author and clinical assistant professor of internal medicine-cardiology at the University of Michigan Medical School, emphasized the importance of recognizing cognitive decline in patients with heart failure.
“Seeing this cognitive decline among patients, and how it worsens over time after a diagnosis of heart failure, should be a warning for providers to assess a patient’s cognitive ability early and factor it into the care plan.”
Factors influencing cognitive decline
Interestingly, common risk factors for cognitive impairment, such as high blood pressure and heart attack, did not account for the rapid cognitive decline observed in the participants with heart failure. The largest decline in cognitive abilities was seen in older adults, women and white participants.
Earlier cognitive decline in heart failure patients
Based on the study’s findings, people with heart failure reached the threshold for meaningful cognitive decline nearly six years earlier than those without the condition. Executive functioning in these individuals deteriorated about four and a half years earlier. The results suggest that regular cognitive monitoring for older adults with heart failure could help identify the earliest signs of cognitive impairment, allowing for timely intervention.
The need for further research
Senior author Dr. Deborah A. Levine, a professor of internal medicine and neurology at U-M Medical School, noted the need for a better understanding of the mechanisms behind this accelerated cognitive decline.
“We need a better understanding of the mechanisms driving accelerated cognitive decline after heart failure to develop interventions that halt or slow the decline,” Levine said.
The findings also shed light on the complex nature of treatment decisions for individuals with heart failure. Cognitive capacity plays a crucial role in managing the disease, as it affects a patient’s ability to follow medical instructions, monitor symptoms and manage medications effectively.
Communication gaps in heart failure care
The study further emphasizes the importance of improving communication with heart failure patients. A previous qualitative study led by Shore found that many patients had a poor understanding of their prognosis, while caregivers were often better at identifying when a patient’s health was declining. Some patients reported that their healthcare providers avoided discussions about prognosis, while others struggled to understand medical jargon.
“Most people with heart failure, as well as their care partners, want discussions around prognosis to begin early in the course of the disease and to be repeated routinely using patient-centered language,” Shore said.
“They want to speak candidly about quality of life and survival assessments. Even though these conversations are tough, people want to have it. With what we know about the rate of cognitive decline in this patient population, there is a major need to meet patients where they are with clarity and compassion to improve overall care in heart failure.”
Reference: Shore S, Li H, Zhang M, et al. Trajectory of cognitive function after incident heart failure. Circ: Heart Failure. 2025;18(3). doi: 10.1161/CIRCHEARTFAILURE.124.011837
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