Forgetfulness in heart failure: more than a symptom, a marker of psychological distress and clinical risk

Background

Subjective cognitive complaints are common in patients with heart failure (HF) and may adversely affect self-care behaviors and disease management. However, clinical and psychosocial factors associated with self-reported forgetfulness in real-world HF populations remain insufficiently characterized.

Methods

This cross-sectional survey study included consecutive patients with HF attending sixteen cardiology outpatient clinics. A structured questionnaire assessed self-reported forgetfulness, treatment adherence, follow-up behaviors, and illness perceptions. Demographic characteristics, HF duration, clinical variables, and comorbidities were recorded. Patients were compared according to the presence or absence of self-reported forgetfulness.

Results

A total of 1060 patients with HF were included, of whom 69,3% reported forgetfulness. Forgetfulness was not associated with sex, educational level, marital status, or employment status (all p > 0.05), (Table 1). Patients with forgetfulness reported lower adherence to physician recommendations , were less likely to use regular medication and were less likely to attend regular follow-up visits (all p < 0.05). In addition, they more frequently endorsed negative illness perceptions, including wishing they had cancer instead of HF, believing that HF is not a disease that can improve, and reporting that they never feel the same as before diagnosis (all p < 0.05)(Table 1) .

Patients with HF duration longer than three years had a significantly higher prevalence of forgetfulness (p <0.05), prevalence of coronary artery disease and chronic obstructive pulmonary disease was similar between groups, whereas diabetes mellitus, hypertension and atrial fibrillation were significantly more frequent among patients reporting forgetfulness (all p < 0.05)(Table 2).

Echocardiographic assessment showed significantly larger left atrial diameters in patients with forgetfulness (45,7±7,6 vs 43,5±6,7 mm, p <0.001), while other echocardiographic parameters were comparable(Table 2). In multivariable analysis, age (OR: 1.042, CI: 1.012-1.072, p=0.005) and left atrial diameter (OR: 1.103, CI: 1.0.50-1.159, p<0.001) remained independently associated with self-reported forgetfulness.

Conclusion

Self-reported forgetfulness in heart failure is more than a symptom, identifying a vulnerable clinical phenotype characterized by structural cardiac remodeling, atrial fibrillation, impaired self-care behaviors, and psychological distress. The independent association between left atrial diameter and forgetfulness may partly reflect the higher burden of atrial fibrillation in this patient group.Table1For image description, please refer to the figure legend and surrounding text.Table 2For image description, please refer to the figure legend and surrounding text.