Table 1.

Characteristics of the 16 Studies Included in the Systematic Review of Cognitive Change in Heart Failure

First Author, Publication Year, (Reference number)	Study Type	Sample Size and Comparison Group	Sample Demographics	Frequency and Timing of Cognitive Assessments	Cognitive Domains Assessed	Treatments/ Interventions	Change in Cognition
Almeida, et al., 2012 (16)	Observational cohort	N=231 HF group: 77 CVD group= 73 Healthy controls=81 - HF group compared to their own, CVD group, and healthy controls at f/u	Mean age(SD): HF group= 68.4 (10.2) CVD, no HF group= 67.8 (9.5) Healthy controls= 69.3 (11.3)	2- baseline,2 years	Global Memory Attention	None (standard clinical treatment assumed)	-HF patients declined in global cognition faster than healthy controls, but not compared to CVD controls - no changes in other domains
Almeida & Tamai, 2001 (17)	Observational cohort	N=81 HF group: 50 (31 with complete f/u)Elderly controls: 31 - Pts’ f/u scores compared to their own and controls’ baseline scores	Mean age(SD): CHF=67.3(0.9) Controls=76.7(1.5) % Male: CHF=76.0 Controls=66.7	2- baseline, 6 weeks	Attention Visuospatial	None (standard clinical treatment assumed)	-HF patients improved on some attention tests -HF group had similar scores for all attention tests at f/u as controls at baseline
Bornstein et al, 1995 (18)	Observational cohort	N=62 (pre-operative) Intervention group: n=7 Control group: n=4 -transplant recipients compared to non-recipients	Mean age: 44.7 (10.6) yrs 75.8% male	2- baseline, 36-months (25-months for transplant recipients)	Global cognition Memory Reasoning/Concept Formation Mental Flexibility/Response Fluency (executive function) Attention/Concentration Other	Heart transplant	-transplanted patients showed 11.6% mean improvement in cognition, controls showed 0% change. - transplanted patients had improvements or less decline in memory, mental flexibility, and attention than non-transplanted pts
Ghali, et al., 2012 (27)	Randomized controlled trial	N=170 Lixivaptan group= 111 Placebo group=59	Mean age(SD): Lixivaptan group=69.1(11.8) Placebo group= 70.6 (11.2) 64% male	2- baseline, 4 weeks	Global Attention	Treatment with lixivaptan (vasopressin receptor antagonist)	-global function and attention improved in both groups, but difference between experimental groups NS
Grimm et al., 1996 (19)	Observational cohort	N=110 (baseline) - 55 heart transplant candidates - 55 healthy controls N=19 (end of f/u) -HF pts’ baseline served as own controls at f/u	Mean age=54.8 (9.2) 92.7% male	3- baseline, 4 and12 months post-transplant	Global cognition Other	Heart Transplant	- improvements in global cognition -improvements in cognition attenuated by in cyclosporine users
Hjelm et al., 2011 (14)	Observational population-based cohort	N=702 -HF=variable, 66–147 -no-HF=variable, 301–511 -HF pts compared to no-HF pts and their own baseline data at f/u	Mean age, yrs: -HF=84.3 (4.1) -no-HF=83.3 (2.9) % male: -HF=67 -no-HF=67 100% White	5- baseline, 2, 4, 6 and 8 years	Memory Processing speed Visuospatial	None (standard treatment assumed)	- HF pts consistently performed lower on almost all cognitive tests -HF pts declined faster than no-HF pts in memory -no-HF pts cognitively “caught up” with HF patients by end of study
Karlsson et al., 2005 (28)	Randomized clinical trial	N=208 (randomized) N=146 (baseline) -intervention=72 -control=74 N=90 (f/u) -pts compared to controls and their own baseline data at f/u	Mean age=76 (7.5) % male=56	2- baselin, 6 months	Global	Nurse-based HF management program	-no significant improvement in cognition found in intervention group vs. control group -% impaired decreased over time (12% to 4%)
Kindermann, et al., 2012 (20)	Observational cohort	N at baseline=70 N at f/u=60 Decompensated HF group=20 Stable HF group=20 Healthy controls=20 - decompensated HF group compared to stable HF and healthy control groups at f/u	Mean age (SD): Decompensated HF group= 60.4(16.4) Stable HF group= 60.6 (16.6) Healthy controls=61.6 (15.4) 75% male	2- baseline, two weeks (14±7 days)	Memory Processing speed Executive function	Standard clinical treatment	-memory, processing speed, executive function improved in decompensated HF group to level of stable HF group, but not to level of healthy controls
Petrucci et al., 2009 (21)	Observational cohort	N=93 (baseline) N=28 (complete data at end of f/u) -pts’ f/u scores compared to baseline	Mean age=50 (14) yrs % male=81	3-1-month (served as baseline), 3and 6 months	Memory Visuospatial Language Processing Speed Executive Function	Left Ventricular Assist Device (LVAD) implantation	-visuospatial perception, memory, and processing speed improved in pts with complete data
Qiu et al., 2006 (15)	Observational population-based cohort	N=1301 -HF=205 -no-HF=1096 -HF pts compared to no-HF pts and their own baseline data at f/u	Mean age, yrs: -HF=83.3 (5.4) -no-HF=81.2 (4.8) % male: -HF=20 -no-HF=74	4- baseline, 4, 6, and 9 years (mean f/u= 5.02 years)	Global cognition (dementia diagnosis)	None (standard treatment assumed)	-HF at baseline associated with HR of 1.84 for dementia at f/u compared to no-HF pts -use of antihypertensives attenuated dementia risk
Riegel, et al., 2012 (22)	Observational cohort	N=279 Average processing speed group=114 Below average processing speed group=165	Mean age (SD): Average PS group=56.1(12.1) Below average PS group=66.3(11.9) 64% male	3- baseline, 3 and 6 months	Global Memory Attention Processing speed	None (standard treatment assumed)	- no significant changes changes in cognition
Schall, et al., 1989 (23)	Observational cohort	N=54 (pre-transplant) N=20 (post-transplant) -patients served as own controls	Mean age, yrs =46 (11) %male= 81.5%	2- baseline, 7.7 months (range=3–15)	Global cognition Memory Visuospatial Other	Heart Transplant	-No change in cognition (except “other”)
Stanek, et al., 2009 (24)	Observational cohort	N=70 (complete cases) -HF=40 -no-HF=35 -HF pts’ scores compared to no-HF patients’ scores and their own baseline	Mean age, yrs=70.7 (7.7) % male= 63	2- baseline and 12 months	Global cognition Memory Attention Verbal fluency Visuospatial Planning/reasoning	None (standard clinical treatment assumed)	-HF pts’ global cognition, attention, verbal fluency, planning/reasoning improved at f/u
Zuccala, et al., 2005 (25)	Observational cohort	N=1511 -HF pts compared at f/u according to their “normalization” status on clinical tests	Mean age, yrs: -impaired=82 (8) -not impaired=76 (10) % male: -impaired=39 -not impaired=50	2- baseline and immediately before hospital discharge (mean=15 +/− 10 days)	Global cognition	None (standard clinical treatment)	-Normalization of hypo/hyperglycemia, hypo/hyperkalemia, and anemia associated with improved global cognition
Zuccala, et al., 2005 (26)	Observational cohort	N=1220 -ACI-inhibitor (ACEI) group=446 -no-ACEI group=774 -pts on (ACEI) compared to patients not on ACEI	Mean age, yrs: -ACEI=79(9) -no-ACEI=79 (9) % male: -ACEI=43 -no-ACEI=47	2- baseline and immediately before hospital discharge [mean=13 (IQR=8–20) days]	Global cognition	Standard treatment with ACEI	-ACEI pts experienced greater improvement in global cognition than no-ACEI pts