Cognitive impairment can significantly affect the level of disability experienced by a patient with heart failure. The level of disability in turn impacts hospital readmissions and the need for institutional care.


Cognitive dysfunction in a patient with heart failure may be reversible or irreversible.


Potentially reversible causes of cognitive impairment:

(1) poor cardiac output, especially with systolic hypotension

(2) medications

(3) other organ failures (renal, COPD with hypoxemia, etc)

(4) major depression


Potentially irreversible causes of cognitive impairment (once fully developed):

(1) dementia (vascular, other)

(2) stroke


If a patient with heart failure shows cognitive dysfunction then trying to identify reversible causes may improve outcomes. Interventions may include:

(1) improving left ventricular ejection fraction (pacemaker, heart transplant, valve replacement, etc)

(2) replacement of drugs causing cognitive dysfunction, if possible

(3) management of mental illness

(4) improved management of comorbid conditions

(5) steps to reduce the risk of stoke


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