Year: 2025
Type: article
Abstract: Background The size/magnitude of cognitive changes after incident heart failure (HF) are unclear. We assessed whether incident HF is associated with changes in cognitive function after accounting for pre-HF cognitive trajectories and known determinants of cognition. Methods This pooled cohort study included adults without HF, stroke, or dementia from six US population-based cohort studies from 1971-2019: Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, Multi-Ethnic Study of Atherosclerosis, and Northern Manhattan Study. Linear mixed-effects models estimated changes in cognition at the time of HF (change in the intercept) and the rate of cognitive change over the years after HF (change in the slope), controlling for pre-HF cognitive trajectories and participant factors. Change in global cognition was the primary outcome. Change in executive function and memory were secondary outcomes. Cognitive outcomes were standardized to a t- score metric (mean [SD], 50 [10]); a 1-point difference represented a 0.1-SD difference in cognition. Results The study included 29,614 adults (mean [SD] age was 61.1 [10.5] years, 55% female, 70.3% White, 22.2% Black 7.5% Hispanic). During a median follow-up of 6.6 (Q1-Q3: 5-19.8) years, 1,407 (4.7%) adults developed incident HF. Incident HF was associated with an acute decrease in global cognition (-1.08 points; 95% CI -1.36, -0.80) and executive function (-0.65 points; 95% CI -0.96, -0.34) but not memory (-0.51 points; 95% CI -1.37, 0.35) at the time of the event. Greater acute decreases in global cognition after HF were seen in those with older age, female sex and White race. Individuals with incident HF, compared to HF-free individuals, demonstrated faster declines in global cognition (-0.15 points per year; 95% CI, -0.21, -0.09) and executive function (-0.16 points per year; 95% CI -0.23, -0.09) but not memory ( -0.11 points per year; 95% CI -0.26, 0.04) compared with pre-HF slopes. Conclusions In this pooled cohort study, incident HF was associated with an acute decrease in global cognition and executive function at the time of the event and faster declines in global cognition and executive function over the following years. Clinical Perspective What is new? Incident heart failure (HF) is associated with an acute decrease in global cognition and executive function at the time of the event and also faster declines in global cognition and executive function during the years after the event, controlling for pre-HF cognitive trajectories. What are the clinical implications? Preventing HF might be an effective strategy for maintaining brain health. Cognition should be assessed after HF diagnosis. HF management should be tailored to cognitive abilities.
Source: Circulation Heart Failure
Authors: Supriya Shore, Hanyu Li, Min Zhang, Rachael Whitney, Alden L. Gross, Ankeet S. Bhatt, Brahmajee K. Nallamothu, Bruno Giordani, Emily M. Briceño, Jeremy B. Sussman, Jose Gutierrez, Kristine Yaffe, Michael Griswold, Michelle C. Johansen, Oscar L. Lopez, Rebecca F. Gottesman, Stephen Sidney, Susan R. Heckbert, Tatjana Rundek, Timothy M. Hughes, William T. Longstreth, Deborah A. Levine
Institutions: University of Michigan, Michigan Medicine, Tsinghua University, Johns Hopkins University, Kaiser Permanente San Francisco Medical Center, Columbia University, University of California, San Francisco, University of Mississippi Medical Center, University of Pittsburgh, National Institute of Neurological Disorders and Stroke, University of Washington, University of Miami, Wake Forest University Health Sciences, Wake Forest University
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: American Heart Association, Northwestern University, University of Minnesota, National Institutes of Health, Kaiser Foundation Research Institute, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute on Deafness and Other Communication Disorders, National Institute of Neurological Disorders and Stroke, National Center for Advancing Translational Sciences
Awards: G1002540797, G1220223050, G1220445869, G124418500, G1261314546, G128745896, Michigan Alzheimer's Disease Core Center, G1338207769, G1359416556, G1401438683, G1409423729, G1443812313, G1518371162, G1539384734, G1623886336, G1649448277, G1670764805, G1686417863, G1803853571, G1844203612, G1886881331, G190379715, G1924893021, G19438214, G2079069761, G2143491823, G2194386449, G2195207551, G2262782284, G228913406, G2339050794, G2391884931, G247538147, G2555427744, G2580996367, G278200998, G2889674361, G3031150197, G3045517347, G3137375862, Atrial fibrillation burden, vascular disease of the brain and cardiac MRI in MESA, G3220743633, G322252321, G3223614423, G3248120388, G3256118428, G3405256882, CHS research resources for the cardiovascular health of older adults, G3541419165, G354227350, End of Life Care in End Stage Heart Failure Patients, G3570589137, G3647016462, G3685010094, G3687594596, G379612770, G3826263370, G3853170735, G3901643820, G394051101, G399481048, Predictors of Alheimers Disease in Mild Cognitive Impairment, G4134660577, G421917476, G4219624527, G423252844, G429397448, G4512137732, G4563812999, G4714600099, G4819198047, G4846232932, G4961862235, G5088122703, G5108002584, G514410172, G5148796768, G517941596, G5185723337, G5251985303, G5267790454, G5364873420, G5450057682, G5479317095, G54938809, Determinants of Alzheimer's Disease in Atrial Fibrillation apart from Stroke: The NOMINATE Study, G5787256936, G581887176, G583528397, G5908135296, G5954722477, CHS Events Follow-up Study, Decision Making for Cardiovascular Therapy in Adults with Mild Cognitive Impairment, G6095866717, G6127571511, G6182174406, G6226795708, G6265038979, G6359107525, Institute for Clinical and Translational Research, G6418484092, G6514094751, G666720426, ARIC Neurocognitive Study (ARIC-NCS) Renewal 2 of 5, G6978868085, Defining the role of Atrial Cardiopathy and Subclinical Cardiac Disease in Acute Ischemic Stroke, G7176672723, G7243995979, G7276788223, G739565590, G766700449, G8018240826, G806768229, G8068269535, Clinical and Translational Science Award, G814392139, G8260701975, G836417160, G84345693, G8518686724, CHS-Transition Phase -268055222, G8761005068, G8892155751, G9000005794, G9000028535, G9000046851, G9000069887, G9000076324, G9000079369, G9000087181, G9000087953, G9000218452, Measurement of cognition and functional decline in Latinx older adults for detection of Alzheimer’s Disease and Related Dementias: A mixed-methods approach, Miami Clinical and Translational Science Institute K12 Program, G905887895, G94668252
OpenAlex ID: W4407674911