According to new research from Michigan Medicine, people with heart failure may lose cognitive ability at an astonishing rate, and mental decline equals gradual aging within just seven years of diagnosis.
In a comprehensive study, which studied nearly 30,000 adults over time, scientists found that heart failure was associated with an immediate decline in cognitive function at diagnosis, followed by an accelerated decline in intellectual capacity, which has continued for many years since then.
The findings, published in the Journal of Circulation: Heart Failure, have attracted serious concerns about the current six million Americans.
“Heart failure is a disease that never goes away and treats it, and it relies heavily on the ability of patients to follow specific instructions, monitor their symptoms and keep up with many different drugs,” said Supriya Shore, assistant clinical professor of internal medicine science at the University of Michigan School of Medicine.
This decline in cognitive abilities creates an unsettling paradox: As patients’ psychological abilities deteriorate, they simultaneously expect to manage an increasingly complex treatment regimen, requiring sharp thinking and careful attention to detail.
The research team examined comprehensive measures of global cognition, including attention and overall psychological competence in problem solving, and more specific functions, such as executive functions, involving planning and decision-making. In patients with heart failure, both decline faster than their health.
Surprisingly, the researchers are that common risk factors for cognitive impairment, such as hypertension and previous heart attacks, do not explain the accelerated decline observed in patients with heart failure. This suggests that something about heart failure itself may be driving cognitive deterioration.
The study shows that adults with heart failure will reach a threshold of meaningful cognitive decline nearly six years ahead of those without the condition. For executive functions, this deterioration will be earlier than four and a half years.
“Regular cognitive monitoring of older people with heart failure will help identify signs of cognitive decline in need of supportive care,” said Deborah A. Levine, professor of internal medicine and neurology at UM Medical School. “We need to better understand the mechanisms driving driving that lead to cognitive decline after heart failure to develop interventions that stop or slow down the decline.”
The impact of this cognitive decline is not just daily management. In a related qualitative study led by Shore earlier this year, researchers found that most heart failure patients have poor prognosis, and their caregivers are more likely to recognize when their patients’ health worsens.
Communication challenges exacerbate the problem. Some patients reported that their doctors avoided difficult conversations about prognosis, while others said they were confused by medical terms.
“Most people with heart failure, as well as their care partners, want to start a discussion around prognosis early in the disease and perform routine repetitions in patient-centered language,” Shore said. “They want to talk frankly about quality of life and survival assessments. Even if these conversations are tough, people want to have it.”
Studies have found that some groups have even greater cognitive decline after heart failure diagnosis. The biggest decrease occurred in older adults, women and white participants, although the researchers did not explain why these population groups may be more vulnerable.
For clinicians, these findings highlight the importance of early evaluation of cognitive function in patients with heart failure and incorporating this information into treatment plans. As cognitive ability declines, patients may need additional support systems, simplified medication regimens, or more involvement of caregivers.
“As we understand the rate at which cognitive declines in this patient population, it is necessary to be clear and compassionate in front of patients to improve holistic care for heart failure,” Shore stressed. ”
As population age and heart failure rates continue to rise, addressing the intersection of heart and cognitive health becomes increasingly urgent. For millions of Americans who manage heart failure, retaining psychological functioning may be as critical as maintaining cardiac function for long-term quality of life.
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