Aims/Introduction: Cognitive impairment is a major comorbidity in patients with chronic heart failure (HF) across a wide range of phenotypes. Using a cluster-analytic approach, we aimed to identify patterns of cognitive deficits in order to identify subgroups of patients, who might benefit from additional psychological diagnostics or intensified therapy.

Methods: Study participants underwent an interdisciplinary cardiological, neurological, psychological and neuroradiological work-up at baseline and sequentially during the follow-up period of 3 years according to pre-specified protocols. For generation of cognitive profiles, we performed hierarchical clustering using Ward´s method and squared Euclidean distance as similarity measure of the three cognitive domains: intensity of attention, memory, and executive functions. The number of clusters was determined through examination of the dendrogram and by identifying the first major change in slope of respective coefficients.

Results: A total of 147 patients (aged 63.9±10.8 years, 23 women [15.6%]) with predominantly mild heart failure (77% NYHA class I or II) without focal neurological deficits were included. Cluster analysis revealed 3 groups: (I) no cognitive deficits (29%); (II) selectively impaired intensity of attention (37%); (III) global cognitive deficits in all domains (34%). Cluster I contained a lower proportion of hypertensive patients (p=0.029), while participants in cluster II suffered less frequently from atrial fibrillation (p=0.049). Patients in cluster III were more likely to be women (28%; p=0.012), have a higher heart rate (p=0.035) and a higher proportion of heart valve operations (p=0.005) in the medical history. Pre-existent heart valve operations correlated with markedly impaired memory (p=0.204, p=0.013), which in turn was a finding almost exclusively observed amongst patient in cluster III.

Conclusion: Three clusters with distinct cognitive profiles could be identified amongst patients with chronic stable heart failure using an unbiased approach. Female sex and previous heart valve surgery clustered with global deficits in all domains of cognition. Future studies need to evaluate, whether this cluster information opens up new opportunities for better tailored wholistic therapy.