Sex-Specific Impacts of Depressive and Cognitive Comorbidity on Self-Care and Quality of Life in Women with Heart Failure: A Narrative Review and Key Informant Perspectives

This narrative review summarizes current evidence for the impact of depressive and cognitive comorbidity on self-care and quality of life (QoL) in women with heart failure (HF). Key informant interviews were conducted to obtain provider and patient perspectives on the assessment and management of these comorbidities in HF. A medical librarian (SV) systematically searched Medline, Embase, CINHAL and PsycINFO for studies of self-care and QoL in women with HF and depressive or cognitive comorbidity. Extracted data included study year, location, purpose, data collection methods, analysis and outcomes. Title and abstract screening were done in duplicate and full-texts reviewed by one rater and audited by a second. Conflicts were resolved by consensus. Inductive thematic analysis was used to analyze interview data. 377 studies were screened and 59 included in the final analysis. Critically, the majority of studies did not do sex comparisons and information for cognitive impairment was particularly limited. Across studies, comorbidity burden and sociocultural context were the main factors influencing self care and QoL in women with HF. Interview themes were that: 1) brain comorbidity increases complexity of care and 2) awareness of brain comorbidity, integration with workflow, and access to specialized services are key implementation considerations for individuals with HF. There is a need for sex-specific approaches to HF care but gaps remain in understanding of sex differences in depressive and cognitive comorbidity in HF. Barriers at the intervention-, provider-, organization- and system-levels need to be addressed to enable routine assessment and specialized care.