The Heart-Brain Axis in Heart Failure: Implications for Neuropharmacological Intervention

Introduction: Cognitive impairment is a prevalent but underrecognized comorbidity in Heart Failure (HF). This review aimed to synthesize recent evidence on the heart-brain axis, focusing on cerebral perfusion, brain structural changes, and their impact on cognition. Methods: We systematically searched PubMed, Scopus, and Web of Science for studies published between 2000 and 2025 using terms related to “heart failure,” “cognitive dysfunction,” “cerebral perfusion,” and “neuroimaging.” Eligible articles were screened for quality, with emphasis on recent, high-impact contributions. Extracted data included neuroimaging markers, neuropsychological outcomes, and mechanistic insights. Results: Across studies, HF was consistently linked to reduced cerebral blood flow, gray matter atrophy, and white matter lesions. These alterations were associated with deficits in attention, memory, and particularly executive function. Advanced imaging modalities confirmed hypoperfusion and brain structural remodeling as key drivers of cognitive decline. Longitudinal data suggest a bidirectional association, whereby impaired cognition worsens self-care and clinical outcomes in HF. Discussion: Systemic hypoperfusion and impaired cerebrovascular regulation appear central in the HF-cognition link. However, heterogeneity in study populations and limited longitudinal evidence remain critical gaps. The findings underscore the need for standardized cognitive screening in HF and for interventions that address both cardiovascular and neurocognitive health. Conclusion: Heart failure contributes to cognitive decline through cerebral hypoperfusion and structural brain changes. Early recognition and integration of cognitive assessment into HF management could improve outcomes and guide future preventive strategies.