Improving cognitive function as a novel way to prevent adverse outcomes in high-risk patients with heart failure

The cornerstone of secondary prevention of heart failure (HF) is identifying high-risk patients for intensive disease management program (DMP). However, heterogeneous aetiologies of hospitalisation and death in HF and lack of a personalised approach have made it extremely challenging to reduce adverse outcomes in HF patients. Disorders of the heart and brain frequently co-exist due to commonly shared patient population, disease processes and pathological mechanisms. This is evident by the high prevalence of cognitive impairment (CI) in patients with HF. The bidirectional relationship between the heart and brain increases the burden of both diseases. My previous findings show that even mild form of CI is among the strongest predictors of readmission or death in HF, and a patient’s cognitive function may dictate how he/she responds to a DMP to reduce adverse outcomes. Although HF patients with CI have the highest risks of developing both dementia and cardiovascular adverse events, there is little guidance on how best to manage these patients. This project will develop an effective and innovative model of healthcare delivery program for HF patients, particularly those with CI. Building on previous findings from my HF and cognitive research,this project will include two major studies to examine effects of a DMP and novel interventions in the care of these high-risk patients. This program will improve cognition, reduce risk of dementia and cardiovascular events, and will be supported by innovative technology for wide scale rollout and implementation. Despite the high prevalence of CI among HF patients and poorer prognosis that CI carries, very little is mentioned in most HF guidelines for the management of CI or dementia. This planned research will address this gap in clinical guidelines for managing dementia and HF. Findings from this research are highly translatable and will transform the way healthcare is delivered to these high-risk patients.