Heart and brain interactions in heart failure: Cognition, depression, anxiety, and related outcomes

Background: Cognitive impairment, anxiety and depression are common in heart failure (HF) patients and its evolution is not fully understood. Objectives: To assess the cognitive status of HF patients over time, its relation to anxiety and depression, and its prognostic impact. Methods: Prospective, longitudinal, single center study including patients enrolled in a structured program for follow-up after hospital admission for HF decompensation. Cognitive function, anxiety/depression state, HF-related quality of life (QoL) were assessed before discharge and during follow-up (between 6th and 12th month) using Montreal Cognitive Assessment (MoCA), Hospital Anxiety and Depression Scale (HADS) and Kansas City Cardiomyopathy Questionnaire, respectively. HF related outcomes were all cause readmissions, HF readmissions and the composite endpoint of all-cause readmissions or death. Results: 43 patients included (67±11.3 years, 69% male); followed-up for 8.2±2.1 months. 25.6% had an abnormal MoCA score that remained stable during follow-up (22.6±4.2 vs. 22.2±5.5; p=NS). MoCA score <22 at discharge conferred a sixfold greater risk of HF readmission [HR=6.42 (1.26-32.61); p=0.025], also predicting all-cause readmissions [HR=4.00 (1.15-13.95); p=0.03] and death or all-cause readmissions [HR=4.63 (1.37-15.67); p=0.014]. Patients with higher MoCA score showed a greater ability to deal with their disease (p=0.038). At discharge, 14% and 18.6% had an abnormal HADS score for depression and anxiety, respectively, which remained stable during follow-up and was not related to MoCA. Conclusions: Cognitive function, anxiety and depressive status remain stable in HF patients despite optimized HF therapy. Cognitive status shall be routinely screened to adopt attitudes that improve management as it has an impact on HF-related QoL and prognosis. Resumo: Introdução: A disfunção cognitiva, ansiedade e depressão são comuns nos doentes com insuficiência cardíaca (IC) e a sua evolução não é integralmente conhecida. Objetivos: Avaliar o estado cognitivo dos doentes com IC ao longo do tempo, a sua relação com ansiedade/depressão e o seu impacto prognóstico. Métodos: Estudo prospetivo, longitudinal, unicêntrico de doentes seguidos num programa estruturado após internamento por IC descompensada. A função cognitiva, estado ansioso/depressivo, qualidade de vida (QV) relacionada com a IC foram avaliadas antes da alta e durante o seguimento (entre 6.°-12.° mês) utilizando o Montreal Cognitive Assessment (MoCA), a Hospital Anxiety and Depression Scale (HADS) e o Kansas City Cardiomyopathy Questionnaire (KCCQ), respetivamente. Avaliaram-se outcomes relacionados com IC: reinternamento por qualquer causa, reinternamentos por IC e objetivo composto de morte/reinternamento. Resultados: Foram incluídos 43 doentes (67±11,3 anos, 69% homens); seguidos por 8,2±2,1 meses. 25,6% tinham um resultado anormal no MoCA que se manteve estável no seguimento (22,6±4,2 versus 22,2±5,5; p=NS). Um resultado do MoCA