Analysis of changes in mental health, cognitive function and self-care behaviors in patients with heart failure: A prospective cohort study

Background. Heartfailure (HF) is a chronic condition affecting tens ofmillions of people worldwide. Despite advances in treatment, its impact on mental health, cognitive function and self-care behaviors remains underexplored, particularly across ejection fraction phenotypes, underscoring the need for comprehensive investigations into these interconnected domains. Objectives. This prospective cohort study investigated changes in affective symptoms, cognitive functioning and self-care behaviors in patients with HF stratified with ejection fraction (EF) phenotypes over 6 months. Materialsand methods.The study included 162 patients aged over 60 years with a diagnosis of HF. Participants wereexamined atenrollmentand after6 months. The Mini-Mental State Examination (MMSE),the Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire-9 (PHQ-9) and the European Heart Failure Self-care Behaviour Scale (EHFScB-9) were used to assess cognitive function, affective symptoms and self-care behaviors. Results. Cognitive impairment indicated with the MMSE was less severe in patients with mildly-reduced HF (HFmrEF) compared to preserved EF (HFpEF) (MMSE median scores: 28 [interquartile range (IQR): 27-29] vs 27 [IQR: 25-28]; p = 0.008). The HADS showed that severity of depression worsened over 6 months, particularly in the HFpEF group (median scores increased from 1 [IQR: 0-4] to 3 [IQR: 0-6]; p = 0.006). Self-care ability declined in all groups as indicated in the increased EHFSc-9 (poorer self-care) median scores, which changed from 28 [IQR: 21-33] at baseline to 29 [IQR: 23-34] at 6 months (p = 0.035). Additionally, NT-proBNP parameters were higher in the HFrEF group (3437.7 pg/mL [IQR: 1336.33-6226.43) compared to both HFmrEF and HFpEF (2171.2 pg/mL [IQR: 806.65-4033.15] and 977.1 pg/mL [IQR: 576.9-3708.95, respectively, p = 0.001). Conclusions. Patients with HF showed significant cognitive decline, increased depressive symptoms and reduced self-care over 6 months, with HFpEF patients exhibiting the most pronounced impairments. Differences in outcomes across HF phenotypes highlight the need for tailored diagnostic and therapeutic strategies to address cognitive and emotional challenges in this population.