Subjective Cognitive Concerns in Patients with Heart Failure: An Integrative Review

BACKGROUND: Cognitive dysfunction is prevalent in patients with heart failure (HF). Subjective cognitive concerns (SCC) refer to an individual's concerns, worries, and difficulties about their own perceived cognitive dysfunction, which may or may not be consistent with scores on objective cognitive assessments (eg, neuropsychological tests). However, little is known about SCC in patients with HF. OBJECTIVE: The purpose of this study was to characterize SCC in patients with HF by identifying the prevalence and severity (aim 1), influencing factors (aim 2), and potential outcomes (aim 3). METHODS: An integrative literature review was conducted by searching CINAHL, PubMed, PsycINFO, and EMBASE. Search keywords were heart failure, subjective, cognit*, concerns, and associated synonyms in combination. Of 453 articles retrieved, 9 were included in this review. RESULTS: The articles reviewed included 567 individuals with HF (ranges of mean age = 49-63 years, female = 0%-49%). The prevalence of SCC in patients with HF was 40% to 91%. Severity of SCC was reported to be mild to moderate. Factors significantly influencing SCC were worse HF severity, more psychological distress (ie, depressive and anxiety symptoms, and perceived stress), multimorbidity (ie, chronic obstructive pulmonary disease, insomnia, higher body mass index), and worse objective cognitive function. Outcomes significantly associated with SCC in HF were poorer quality of life and health-related quality of life, less participation in meaningful activities (ie, instrumental, leisure, and social activities) and increased efforts to maintain HF self-care. CONCLUSIONS: In this sample, SCC were highly prevalent in HF, with mild to moderate severity. Potentially influencing factors and outcomes may guide future studies identifying at-risk individuals for SCC and improving health outcomes in HF.