Practices and barriers in screening for cognitive impairment in heart failure: a clinician survey

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BACKGROUND: Cognitive impairment (CI) affects a significant percentage of heart failure (HF) patients, reducing adherence and worsening outcomes. Routine cognitive assessment remains limited. OBJECTIVES: To evaluate cognitive assessment practices, identify barriers, and examine associations between knowledge, attitudes, and clinical behaviours among clinicians managing HF patients. METHODS: An anonymous cross-sectional survey was distributed to 120 cardiologists across 68 clinics in the Hellenic Heart Failure Clinics Network (May-June 2025). The 13-question survey examined knowledge on cognitive decline, personal opinions on screening, assessment methods, and implementation obstacles. Associations were examined using Pearson's chi-square. RESULTS: Fifty-one cardiologists completed the survey, corresponding to a response rate of 42.5%. Among respondents 80% reported awareness of the high prevalence of cognitive decline, 14% systematically screened for CI presence. Main barriers reported were lack of time (76%) and inadequate familiarity with assessment tools (50%). Screening frequency was not associated with HF patient volume (χ2 = 4.75, P = .58). Significant correlations were demonstrated between (i) knowledge on CI and frequency of screening (V = 0.37, P = .04); (ii) frequency of screening and support of establishing screening as routine practice (V = 0.50, P < .001); and (iii) frequency of screening and referral of patients to specialists (V = 0.39, P = .007). All respondents expressed interest in further education. CONCLUSION: There is a gap between awareness of and testing for CI in HF patients, with the latter not being affected by clinicians' patient load. Since there is universal interest in learning, integrating screening tools into daily routines and creating clear referral pathways may help in addressing this evidence-practice gap.

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