LAUSR

Cognitive impairment is prevalent among patients with heart failure (HF) and impacts long-term outcomes.1 The reduction in cerebral perfusion, microvascular damage and cerebral infarcts, decreased cardiac output and low blood pressure, and alterations in cerebrovascular reactivity may trigger and aggravate the cognitive alterations in HF patients.2 Compared to HF patients without cognitive impairment or dementia, those with cognitive alterations are more likely to be readmitted and to die from any cause.3 An interplay of several factors contributes to the poor outcome of HF patients with cognitive impairment, including the deterioration in the ability for self-care, the need for social, third-person or institutional support, the incapacity of adhering to treatment regimens (especially complex regimens with multiple pills), the difficulty in describing symptoms and changing health behaviours.4 Despite the growing knowledge about the impact of cognitive alterations in HF, little is known on how to improve cognitive function and how cognitive alterations may impact specific HF interventions, including HF management programmes. In this issue of the Journal, Huynh and colleagues present an interesting analysis aiming to determine if the degree of cognitive impairment could influence the response to a HF management programme.5 From a total pool of 1152 patients that had been prospectively followed for 1 year, 324 (28%) received a HF disease management programme (HF-DMP) with a 1-month duration that included post-discharge phone calls and home visits, therapeutic and self-care education, transition of care (with a ‘transition’ coach), exercise guidance and clinical review/assessment. As the