HF, independent of ejection fraction alone, is associated with cognitive impairment, with HF with reduced EF showing the highest prevalence of moderate to severe cognitive impairment.
Key Findings
Results
Lower ejection fraction was significantly associated with worse cognitive performance after adjustment for covariates.
Linear regression showed a post-adjustment β=0.033, P=0.013 for the correlation between ejection fraction and Montreal Cognitive Assessment (MoCA) score
The association persisted after adjusting for age, sex, race, and vascular risk factors
Total cohort included 1592 patients with mean age 75.7±13.8 years, 48.5% women
Patients were seen at Mayo Clinic in 2022 and underwent both echocardiogram and cognitive assessment within 1 year
Results
Patients with HF with reduced EF (HFrEF) and HF with preserved EF (HFpEF) had significantly lower MoCA scores than those without HF.
Mean MoCA scores were 17.6±6.2 for HFrEF, 18.9±5.8 for HFpEF, and 19.9±6.0 for no HF (P<0.001)
HF with mildly reduced EF was not reported as significantly different from no HF in mean MoCA scores
MoCA score categories were: normal (≥26), mild impairment (18–25), and moderate to severe impairment (<18)
HF was classified per the 2022 American Heart Association criteria into no HF, HFpEF, HF with mildly reduced EF, and HFrEF
Results
The prevalence of moderate to severe cognitive impairment was highest in HFrEF and followed a non-monotonic pattern across HF subtypes.
Prevalence of moderate to severe cognitive impairment (MoCA <18) was 43.3% in HFrEF, 34.4% in HFpEF, 28.6% in no HF, and 23.4% in HF with mildly reduced EF
The adjusted trend across HF subtypes was statistically significant (P=0.032)
HF with mildly reduced EF had the lowest prevalence of moderate to severe cognitive impairment among all groups, including the no HF group
The association between HF subtypes and cognitive dysfunction was assessed using logistic regression adjusted for age, sex, race, and vascular risk factors
Conclusions
Heart failure is associated with cognitive impairment independent of ejection fraction alone.
The study used a cross-sectional design of patients aged ≥18 years seen at Mayo Clinic in 2022
Inclusion required both echocardiogram and cognitive assessment (MoCA) within 1 year
The authors conclude that 'HF, independent of ejection fraction alone, is associated with cognitive impairment'
The authors call for further studies to confirm findings and evaluate the impact of interventions targeting EF and HF subtypes on cognitive outcomes
Methods
The study population was predominantly older adults with a near-equal sex distribution.
Mean age of the cohort was 75.7±13.8 years
48.5% of participants were women
Total sample size was 1592 patients
The cohort represented a real-world health care system population from a single institution (Mayo Clinic) in 2022
What This Means
This research suggests that heart failure — regardless of its specific subtype — is linked to poorer cognitive performance in real-world patients. The study looked at 1,592 patients at the Mayo Clinic who had both a heart ultrasound (echocardiogram) and a cognitive test (the Montreal Cognitive Assessment, or MoCA) within the same year. It found that patients whose hearts pump less efficiently (lower ejection fraction) tended to score worse on the cognitive test, and that both major types of heart failure — the kind where the heart pumps weakly (HFrEF) and the kind where the heart pumps normally but stiffens (HFpEF) — were associated with significantly lower cognitive scores compared to people without heart failure.
The most striking finding was that over 43% of patients with the reduced-pumping type of heart failure had moderate to severe cognitive impairment, compared to about 34% with the preserved-pumping type and about 29% with no heart failure. Interestingly, patients with a middle category called 'mildly reduced ejection fraction' had the lowest rate of severe cognitive impairment of any group, which the researchers note warrants further investigation. The study adjusted for factors like age, sex, race, and other vascular risk factors to make the comparisons more meaningful.
This research suggests that the relationship between heart function and brain health is complex and not fully explained by how hard the heart pumps alone. It highlights the importance of monitoring cognitive health in heart failure patients across all subtypes, not just those with the most severely weakened hearts. The authors call for future studies to determine whether treating heart failure or improving heart pumping function can also help protect or improve cognitive outcomes.
Satyadev N, Lasiichuk I, Shourav M, Vallamchetla S, McGrath C, Monsanto M, et al.. (2026). Cognition and Heart Failure Subtypes: A Large Health Care System Real-World Cohort.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.126.051559