Heart failure is an endemic disease affecting 250 000 Swedes. Despite new treatments such as modern medicines and defibrillators, the mortality rate is still high and the prognosis worse than for certain cancers. A new study from Lund University in Sweden now shows a link between cognitive impairment and an increased risk for rehospitalisation, or an early death, in heart failure patients.

Researchers at Skåne University Hospital and Lund University conducted the new study, published in the medical journal ESC Heart Failure. It is the first study in which cognitive impairment is linked to worse prognoses in a larger group of heart failure patients who have received care at Skåne University Hospital in Malmö.

Cognitive ability refers to, for example, memory, the ability to orient oneself in time and place, problem solving and the use of numbers and language.

"The patients were asked to complete three different cognitive tests within the framework for the study. The independent connection we could see was that patients who performed worse on the tests arewere at an increased risk of rehospitalisation and at an increased risk of death", says Martin Magnusson, consultant in cardiology at Skåne University Hospital and adjunct professor at Lund University.

The study looked at 281 patients of whom 80 demonstrated cognitive impairment in the tests. However, only four of them were previously aware that their cognitive ability was impaired.

"It could be that this patient group has a reduced ability to comply with evidence-based treatment recommendations - particularly if they are unaware of their cognitive impairment. However, this has not been studied", says Martin Magnusson.

Hannes Holm, resident physician in cardiology at Skåne University Hospital and post doc in Martin Magnusson's research group, emphasises that the study only shows a link between the results of the cognitive tests and the rehospitalisation and death of heart failure patients.

"As yet, we still do not know if it is the cognitive impairment that has this effect on the prognosis of heart failure patients, or if it is the heart failure itself that affects the cognition", says Hannes Holm.

It has also not been studied how heart failure patients would react to being screened for cognitive function and then receive cognitive support in their heart failure treatment.

"This is something we want to look at further. If our hypothesis is correct, it could mean that this patient group can be offered greater support in their cognitive ability, which in turn can be a simple and pragmatic way to save more lives", says Martin Magnusson.