TRAJECTORY OF COGNITIVE DECLINE BEFORE AND AFTER INCIDENT HEART FAILURE: A PROSPECTIVE COHORT STUDY

Therapeutic Area Heart Failure Background Whether and to what degree the development of heart failure accelerates cognitive decline is not well understood. Methods We used data from the Health and Retirement Study (waves 5 through 15, 2000-2020), which is a nationally representative survey of US adults aged 50 years or older. Individuals were excluded if they had a history of cognitive impairment, heart failure, coronary artery disease, or stroke at baseline. Participants underwent a cognitive assessment at baseline and ≥1 time during follow-up. The outcomes assessed included change in global cognition, memory, and executive function. Outcomes were standardized into Z-scores, with higher scores indicating better cognitive performance. Linear mixed effects models was used to estimate changes in cognition at the time of HF diagnosis (change in the intercept) and the rate of cognitive change over the years after incident HF (change in the slope), with adjustments for pre-HF cognitive trajectories and potential confounders, including demographics, lifestyle factors, and medical history. Results Among 12,850 participants, over a median follow-up of 16 years (interquartile range: 8 to 20 years), 1,457 individuals developed incident HF. The annual rate of cognitive decline before HF diagnosis among individuals with incident HF was similar to that of participants who remained HF-free throughout follow-up. However, incident HF was associated with an acute decline in global cognition (-0.073 SD [95% CI -0.109 to -0.038]), memory (-0.070 SD [95% CI -0.108 to -0.032]), and executive function (-0.054 SD [95% CI -0.092 to -0.016]). Moreover, individuals with incident HF vs those without HF demonstrated a faster trajectory of decline in global cognition (-0.011 SD/year [95% CI -0.018 to -0.004]) and executive function (-0.008 SD/year [95% CI -0.015 to -0.001]), but not in memory (-0.006SD/year [95% CI -0.013 to 0.001]) in the years post-HF diagnosis compared with their pre-diagnostic trajectory. Conclusions Incident HF led to both an acute decline in cognitive function and an accelerated trajectory of cognitive decline in the subsequent years. Our data suggests that among individuals who develop heart failure, increased surveillance for signs of cognitive impairment may be warranted.