Aims: Cognitive impairment is prevalent in heart failure and is associated with impaired self management, increased hospital readmission, and mortality. Despite these, cognitive screening is not routinely integrated into heart failure care. This narrative review outlines the rationale, evidence base, and practical considerations for incorporating routine cognitive assessment into heart failure management, with a focus on selecting appropriate screening tools.
Methods: A narrative synthesis of the literature examined the prevalence, mechanisms, and clinical consequences of cognitive impairment in heart failure. Evidence was reviewed the sensitivity, and clinical utility of commonly used cognitive screening instruments to inform pragmatic implementation in routine practice.
Results: Approximately 40% of patients with heart failure experience cognitive impairment, most commonly affecting executive function, attention, and memory. These significantly compromise medication adherence and self care ability. Proposed mechanisms include chronic cerebral hypoperfusion, neuroinflammation, blood brain barrier dysfunction, collectively described as cardiocerebral syndrome. Effective screening tools in this population must be brief, feasible, and sensitive to deficits across multiple cognitive domains, particularly executive function. The Mini-Mental State Examination demonstrates limited sensitivity in heart failure, whereas screening tools that assess multidomain include executive assessment more reliably identify cognitive impairment relevant to heart failure outcomes.
Conclusions: Cognitive impairment is a common yet under-recognised barrier to effective heart failure management. Embedding routine cognitive screening into clinical care is a practical, evidence based strategy that enhances risk stratification, enables personalised care, supports safer transitions across care settings. Screening tools used in this population should be sensitive to impairments across multiple cognitive domains.