Table 1.
Studies examining the prevalence of cognitive impairment in patients with heart failure
| Study | Sample | Population | Median age in years (SD) | Study methodology | Inclusion criteria | Exclusion criteria | CV measures/criteria | Cognitive assessment tool(s) used | Results |
|---|---|---|---|---|---|---|---|---|---|
| Zuccalà 1997 [6] | 57 HF pts | Consecutive admissions to hospital | 77 | Cross-sectional | Not specified | Co-morbid psychiatric or physical illness and previous diagnosis of CI | LVEF (mean EF 45%) NYHA II-III |
MMSE, MDBandRCPM | 53% of HF pts showed global CI with MMSE less than 24 |
| Callegari 2002 [7] | 64 HF pts, 321 healthy controls | Age <65 years and consecutive admissions to hospital | 52 (8) | Cross-sectional | Not specified | Co-morbid psychiatric or neurological illness. Previous diagnosis of CI and female sex | LVEF <50% | Multidomain neuropsychiatric battery | HF pts scored lower than control group in short-term verbal memory, short-term visuospatial memory and visual spatial logical ability |
| NYHA I-III | |||||||||
| Cardiopulmonary testing with treadmill | |||||||||
| Right heart catheterisation | |||||||||
| Trojano 2003 [8] | 149 HF NYHA II pts | Age >65 years and consecutive admissions to hospital | HF NYHA II: 75 (7) | Cross-sectional | Not specified | Co-morbid psychiatric, neurological or physical illness. Previous diagnosis of CI | No measure of LV function | Multidomain neuropsychiatric battery | HF pts scored worse than those without HF in domains of: attention, verbal fluency, verbal learning |
| 159 HF NYHA III/IV | HF NYHA III/IV: 77 (7) | NYHA II-IV | No significant difference between pts with moderate or severe HF | ||||||
| 207 non-HF controls | Non-HF controls: 74 (7) | ||||||||
| Zuccalà 2005 [9] | 1,511 HF pts, 11,790 control patients | All geriatric or general medical hospital admissions | 79 (9) | Cross-sectional | Not specified | Not specified | HF diagnosis based on discharge documentation | Hodkinson abbreviated mental test | 35% of HF pts showed global CI 29% of non-HF pts showed global CI |
| Feola 2007 [10] | 60 HF-REF | Consecutive admissions to hospital | 66 | Cross-sectional | HF-REF: clinical HF, NYHA II-IV, LVEF ≤50% | Not specified | LVEF | Multidomain neuropsychiatric battery | 23% of HF pts showed global CI |
| 12 HF-PEF | HF-PEF: diagnosed based on E/A ratio, deceleration time and LV dilatation | NYHA II-IV | |||||||
| BNP | |||||||||
| Debette 2007 [11] | 83 HF pts | Consecutive admissions to hospital | 62 | Cross-sectional | Not specified | Hearing/visual impairment | LVEF <45% | MMSE | 61% of HF pts showed global CI |
| NYHA I-IV | |||||||||
| Dodson 2013 [12] | 282 decompensated HF pts | Age >65 years and non-consecutive admissions to hospital | 80 (8) | Prospective | English speaking | Co-morbid psychiatric illness | HF diagnosis based on documentation in medical records | MMSE | 25% of HF pts showed evidence of mild CI 22% of HF pts showed moderate to severe CI |
| Schmidt 1991 [13] | 20 iDCM pts | Age <50 years and ambulatory outpatients only | iDCM: 38 (5) | Cross-sectional | Not specified | Co-morbid psychiatric, neurological or physical illness | LVEF 14-45% | LGT-3 and ALID | Systolic HF pts performed worse than the control group in domains of attention, learning and memory and reaction time |
| 20 healthy controls | Healthy controls: 41 (8) | NYHA II-IV | |||||||
| Grubb 2000 [14] | 20 HF pts with CADs | Ambulatory outpatients only | HF: 68 | Cross-sectional | Not specified | Co-morbid psychiatric or neurological illness. Previous hospital admission within 6 months | HF: LVEF <40%, NYHA III/IV | RBMT and WMS | No difference between HF pts and control group |
| 20 CAD control | CAD controls: 67 | CAD controls: LVEF >55%, no CHF | |||||||
| Riegel 2002 [15] | 42 HF pts | Ambulatory outpatients only | 75 (12) | Cross-sectional | English speaking | Co-morbid physical or psychiatric illness | No measure of LV function | MMSE and CIMS | 29% of HF pts showed evidence of global CI |
| NYHA I-IV | |||||||||
| Vogels 2007 [16] | 62 HF pts | Age >50 years and ambulatory outpatients only | HF: 69 (9)) | Case control | HF pts: diagnosis of HF >6 months and stable on medication >4 weeks | Co-morbid physical, neurological or psychiatric illness. Previous diagnosis of CI | LVEF <40% | Multidomain neuropsychiatric battery | HF pts scored lower than the healthy control group in all domains |
| 53 CAD controls | CAD controls: 69 (10) | CAD controls: IHD but no clinical CHF and EF >40% | NYHA II-IV | HF pts scored lower than the IHD control group in domains of memory and mental speed | |||||
| 42 healthy controls | Healthy controls: 67 (9 | IHD control group scored lower than the healthy control group in language only | |||||||
| Hoth 2008 [17] | 31 HF pts | Age >55 years and ambulatory outpatients only | HF: 69 (9) | Cross-sectional | English speaking | Co-morbid physical, neurological or psychiatric illness. Previous diagnosis of CI | LVEF <40% | Multidomain neuropsychiatric battery | Systolic HF pts scored lower than the IHD control group in domains of executive function and cognitive flexibility |
| 31 CAD controls | CAD controls: 69 (9) | Minimum of 8th grade education | NYHA II-IV | ||||||
| CAD controls: angina/previous MI/PCI/PVD and HF excluded on basis of clinical examination | |||||||||
| Beer 2009 [18] | 31 HF pts | Ambulatory outpatients only | HF: 54 (11) | Case control | Not specified | Co-morbid neurological illness or previous diagnosis of CI | LVEF <40% | Block design, CVLT and 'F,A,S test' | Systolic HF pts scored lower than control group in all cognitive domains |
| 24 healthy controls | Healthy controls: 56 (8) | NYHA II | |||||||
| LWHFQ | |||||||||
| Stanek 2009 [19] | 40 HF pts, 35 CAD controls | Ambulatory outpatients only | 70 (8) | Prospective | English speaking | Co-morbid psychiatric or neurological illness. Previous diagnosis of CI | NYHA II-III | DRS | No difference between systolic HF pts and CAD control patients in all domains |
| CAD controls: history of MI, CAD, cardiac surgery, hypertension | CO <4 L/minute on echo | ||||||||
| Sauvé 2009 [20] | 50 HF pts 50 healthy controls |
Age >30 years in HF pts and >55 years in controls. Ambulatory outpatients only | HF: 63 (14) Healthy controls: 63 (14) |
Case control | Diagnosis of HF >6 months | Co-morbid psychiatric or neurological illness | LVEF ≤40% NYHA II-IV |
Multidomain neuropsychiatric battery | Systolic HF pts scored lower than control group in domain of verbal memory |
| Pressler 2010 [21] | 249 HF pts | Ambulatory outpatients only | HF: 63 (15) | Cross-sectional | HF: LVEF ≤40% and clinical HF | Co-morbid psychiatric, neurological or physical illness. Previous diagnosis of CI | NYHA | Multidomain neuropsychiatric battery | HF group performed worse than healthy and general medical groups in domains of memory, executive function and psychomotor speed |
| 63 healthy controls | Healthy controls: 53 (17) | Healthy controls: absence of any medical condition or controlled CV risk factors | LVEF | ||||||
| 102 general medical pts | Medical group: 63 (12) | Medical group: major chronic disorder other than HF | |||||||
| Bauer 2012 [22] | 51 HF-REF, 29 HF-PEF | Age >21 years and ambulatory outpatients only | 72 (12) | Cross-sectional | HF-REF: history of HF-REF >6 months, stable on medication >4 weeks, LVEF ≤40% | Co-morbid psychiatric, neurological or physical illness. Previous diagnosis of CI | LVEF | Multidomain neuropsychiatric battery | HF-REF and HF-PEF pts performed worse than age- and educated-adjusted healthy control groups in executive function, attention, language, memory and psychomotor speed |
| HF-PEF: history of HF-PEF >6 months, stable on medication >4 weeks, LVEF >41% | NYHA | ||||||||
| Festa 2011 [23] | 169 HF-REF, 38 HF-PEF | Age >17 years and ambulatory outpatients only | 69 | Retrospective | On medical treatment for HF | Co-morbid neurological illness | LVEF | Multidomain neuropsychiatric battery | Low EF was associated with poor memory in pts over 63 years old |
| Haemodynamically stable | Pts <63 years old had preserved memory function regardless of EF. | ||||||||
| Not receiving mechanical circulatory support | |||||||||
| Steinberg 2011 [24] | 55 HF pts | Ambulatory outpatients only | 55 (8) | Cross-sectional | Stable clinical status | Co-morbid neurological or physical illness. Previous diagnosis of CI | LVEF ≤45% | Multidomain neuropsychiatric battery | 44% of HF pts showed evidence of global CI |
| NYHA I-III | |||||||||
| 6 minute walk test | |||||||||
| Jefferson 2011 [25] | 1,114 pts from Framingham Heart Study | Age >40 and <89 years and ambulatory outpatients only | 67 (9) | Cross-sectional | Not specified | Co-morbid neurological illness or previous diagnosis of CI | LVEF | Multidomain neuropsychiatric battery | U-shaped association between LVEF and cognitive performance |
| Cardiac MRI | |||||||||
| Miller 2012 [26] | 140 HF pts | Age >50 and <85 years and ambulatory outpatients only | 69 (9) | Cross-sectional | English speaking | Co-morbid psychiatric or neurological illness | No measure of LV function | Multidomain neuropsychiatric battery | 62% of HF pts showed evidence of global CI |
| No NYHA classification | |||||||||
| 2 minute step test | |||||||||
| Almeida 2012 [27] | 35 HF pts | Age >45 years and ambulatory outpatients only | HF: 69 (9) | Cross-sectional | HF: EF <40%, clinical HF ≥6 months, English speaking, NYHA I-III | Co-morbid psychiatric, neurological or physical illness. Previous diagnosis of CI | LVEF | Multidomain neuropsychiatric battery | HF pts scored lower than the healthy control group in domains of immediate/long-term memory and psychomotor speed |
| 56 CAD controls | CAD controls: 67 (10) | CAD controls: previous MI, English speaking, EF ≥60%, no clinical HF | NYHA | No difference between the HF group and IHD control group in cognition | |||||
| 64 healthy controls | Healthy controls: 69 (11) | Healthy controls: English speaking, no previous MI/angina, EF ≥60% | |||||||
| Hawkins 2012 [28] | 251 HF pts | Ambulatory outpatients only | 66 (10) | Cross-sectional | English speaking | Co-morbid psychiatric illness. Previous diagnosis of CI | LVEF ≤40% | Multidomain neuropsychiatric battery | 58% of HF pts had CI with poor scores in the domains of verbal learning and verbal memory |
| Bratzke-Bauer 2013 [29] | 47 HF-REF | Age >50 years and ambulatory outpatients only | HF-REF: 75 (9) | Cross-sectional | History of HF >6 months | Co-morbid psychiatric, neurological or physical illness. Previous diagnosis of CI | LVEF | Multidomain neuropsychiatric battery | 23% of the HF-REF cohort showed evidence of CI |
| 33 HF-PEF | HF-PEF: 68 (15) | Stable on medication ≥4 weeks | NYHA | 3% of the HF-PEF cohort showed evidence of CI | |||||
| HF-PEF based on AHA criteria | |||||||||
| Huijts 2013 [30] | 491 HF-REF | Age >60 years and ambulatory outpatients only | 77 (8) | Prospective | HF-REF: hospitalization within past year | Co-morbid physical illness | HF-REF: LVEF <45%, NYHA II-IV, NT-proBNP >400 pg/ml | AMT | 8% of HF-REF group showed evidence of severe CI (AMT ≤7) |
| 120 HF-PEF | HF-PEF: NT-proBNP ≥400 pg/ml if pt <75 years or ≥800 pg/ml if pt ≥75 years | HF-PEF: LVEF ≥45% | 13% of HF-PEF group showed evidence of severe CI (AMT ≤7) | ||||||
| Kindermann 2012 [31] | 20 decompensated HF pts | Decompensated HF: non-consecutive admissions to hospital | Decompensated HF: 60 (16) | Prospective | Decompensated HF: caused by ischaemic or DCM, symptomatic HF for ≥6 months, clinical signs of decompensation, for example, raised JVP | Co-morbid psychiatric, neurological or physical illness. Previous diagnosis of CI | LVEF <45% | Multidomain neuropsychiatric battery | Decompensated HF group scored lower than stable HF group in domains of memory, executive control and processing speed |
| 20 stable HF pts | Stable HF: outpatients | Stable HF: 61 (17) | Stable HF pts: CHF of ischaemic or DCM, NYHA III-IV, no clinical signs/history of decompensation for ≥3 months | NYHA III/IV | Stable HF group scored lower than the healthy control group in domains of intelligence and episodic memory | ||||
| 20 healthy controls | Healthy controls: 62 (15) |
AHA, American Heart Association; ALID, adjective list of Janke and Debus; AMT, Abbreviated Mental Test; BNP, brain natriuretic peptide; CAD, coronary artery disease; CHF, congestive heart failure; CI, cognitive impairment; CIMS, complex ideational material subset; CO, cardiac output; CV, cardiovascular; CVLT, California Verbal Learning Test; DCM, dilated cardiomyopathy; DRS, Disability Rating Scale; E/A ratio, ratio of mitral peak velocity of early filling (E) to mitral peak velocity of late filling (A); EF, ejection fraction; HF, heart failure; HF-REF, heart failure-reduced ejection fraction; HF-PEF, heart failure-preserved ejection fraction; iDCM, idiopathic dilated cardiomyopathy; IHD, ischaemic heart disease; JVP, jugular venous pressure; LGT-3, Lern und Gedachtnistest; LV, left ventricular; LVEF, left ventricular ejection fraction; LWHFQ, Living With Heart Failure Questionnaire; MDB, mental deterioration battery; MI, myocardial infarction; MMSE, Mini-Mental State Examination; MRI, magnetic resonance imaging; NT-pro BNP, N-terminal prohormone brain natriuretic peptide; NYHA, New York Heart Association; pts, patients; PCI, percutaneous coronary intervention; PVD, peripheral vascular disease; RBMT, Rivermead Behavioural Memory Test; RCPM, raven coloured progressive matrices; SD, standard deviation; WMS, Weschler Memory Scale.