The mind of a failing heart: a systematic review of the association between congestive heart failure and cognitive functioning

Background: Congestive heart failure (CHF) is a frequent complication of most diseases of the heart. CHF is associated with impairment in several aspects of the quality of life of patients, including mood and cognitive performance. Early reports indicated that patients with CHF display deficits in memory and other intellectual abilities, although the clinical relevance of these findings remains unclear. Aim: We reviewed systematically the medical literature with the aim of clarifying the association between CHF and cognitive functioning. Methods: Systematic review of Medline database for studies published between 1966 and June 2000 using the following key words: congestive heart failure, cognition, cognitive disorders, memory, memory disorders, short-term memory, attention. Results: Thirteen studies reported cognitive information on patients with CHF, but only five met inclusion criteria for systematic review. Three reports described attention (total number of subjects = 369 patients and 882 controls) and memory scores (total number of subjects = 247 patients and 748 controls), two studies reported measures of general cognitive functioning (total number of subjects = 203 patients and 704 controls) and one reported the rate of cognitive impairment (total number of subjects = 88 patients and 987 controls). Pooled analysis indicated that CHF is associated with a pattern of generalized cognitive impairment that includes memory and attention deficits. Conclusions: The results of the present review highlight the enormous paucity of systematic information about the association between CHF and cognitive functioning, with only five studies reporting data suitable for analysis. We expect that new case-control and cohort studies will be designed to confirm the presence of cognitive impairment in patients with CHF and trust that this information will improve the management of CHF patients and our understanding of the mechanisms associated with cognitive decline in later life.