Symptom: Confusion

Confusion is a common symptom of heart failure (HF). It may appear as memory loss or impaired thinking. A caregiver or relative often notices confusion before the person with HF does.¹

Confusion and memory loss are often linked to conditions of the nervous system. These are known as neurological conditions, such as Alzheimer’s disease. But many people with HF also experience these symptoms.^2,3

What does confusion look like?

Problems with thinking (cognitive symptoms) are common in people with HF. They can occur in people with HF at any age. People with more advanced HF have a higher risk of confusion. The risk is also higher for people with HF who:^2-4

• Are women
• Have high blood pressure
• Have diabetes
• Are obese

Changes to mental function look different for everyone with HF. Also, some of the symptoms of confusion can also be side effects of certain medicines. Symptoms include:⁵

• Lightheadedness
• Dizziness
• Feeling disoriented

As HF progresses, the condition may impair the ability to think. This confusion may be accompanied by memory loss. Many people with this level of impairment are already hospitalized with HF. Confusion can have a serious impact on quality of life. For example, it can affect your ability to:^1,5

• Work
• Drive
• Live independently
• Communicate with others
• Follow your treatment plan

Why does heart failure cause confusion?

The links between HF and confusion are complex and not fully understood. In people with HF, the heart struggles to pump enough blood to the body. This can reduce how much blood gets to the brain (cerebral blood flow). Poor circulation to the brain can cause confusion and other symptoms.^1-3

Chronic inflammation in HF may also contribute to cognitive symptoms. People with HF have higher levels of inflammatory chemicals in their bodies. This may cause damage to certain areas of the brain.^2,3

Another possible link is in features that HF shares with neurodegenerative conditions. These are conditions in which nerve cells stop working as well as they once did and die off. For example, clumps of protein cause cell death in both Alzheimer’s disease and certain heart conditions. But this is unlikely to be the cause of confusion for most people with HF.^2,3,6

How is confusion treated?

Talk to your doctor about the symptoms you experience or notice in your loved ones. They will ask about the symptoms, when they started, and how long they last. Tell them about:³

• Changes in medicines the person with confusion takes
• Changes in eating habits
• Changes in sleep habits
• Head injuries
• Recent illnesses

People with HF who experience confusion tend to have worse health outcomes. Cognitive symptoms increase the risk of hospital admission and death from HF. This may be because confusion makes it harder to care for yourself and take your medicines as prescribed.^2,3

The first treatments for confusion are often acetylcholinesterase inhibitors and memantine. These medicines may have side effects for people with HF. Some treatments for HF may also improve thinking and memory. But experts have only found limited evidence of their benefits through clinical trials. These treatments include:^2,3

• ACE inhibitors
• Sodium-glucose co-transporter 2 inhibitors
• Angiotensin receptor neprilysin inhibitors
• Beta-blockers
• Cardiac resynchronization therapy

Lifestyle changes can also improve thinking and memory in people with HF. These changes include regular exercise and a balanced diet.³