Development of a simple clinical risk score to predict cognitive impairment in older adults with HFpEF
D A Arnautu, K I Gyalai, M Andor, D C Jianu, S F ArnautuAbstract
Background
Cognitive impairment is a common yet underrecognized comorbidity in older adults with heart failure and preserved ejection fraction (HFpEF). It worsens prognosis, limits self-care, and complicates treatment adherence. Despite its importance, determinants of cognitive dysfunction in this population remain insufficiently defined, particularly in Central and Eastern Europe. This study aimed to identify major predictors of cognitive impairment in elderly HFpEF patients and to develop a simple, point-based risk score for early detection and clinical application.
Methods
A cross-sectional study was conducted in HFpEF patients aged ≥65 years. Clinical, echocardiographic, and laboratory parameters were collected. Cognitive status was evaluated using the Mini-Mental State Examination–2 (MMSE-2), with cognitive impairment defined as a score <24. Variables significant on univariate analysis were entered into multivariable logistic regression to identify independent predictors of cognitive dysfunction. A point-based risk score was derived by weighting variables according to β coefficients from the regression model.
Results
A total of 326 HFpEF patients were included. The prevalence of cognitive impairment was high. Independent predictors included diabetes mellitus, prior stroke or transient ischemic attack (TIA), carotid artery disease, elevated N-terminal pro–B-type natriuretic peptide (NT-proBNP), and reduced estimated glomerular filtration rate (eGFR). Conversely, higher Kansas City Cardiomyopathy Questionnaire (KCCQ-12) scores and anticoagulant therapy for atrial fibrillation were associated with a lower risk of impairment. Each variable in the final model was selected for clinical relevance and statistical significance (p < 0.05). Continuous predictors were categorized using clinically meaningful cutoffs, and β coefficients were scaled and rounded to the nearest integer for simplicity. Variables associated with increased risk received positive points, while protective factors received negative values. The cumulative score reflected the overall cognitive risk in elderly HFpEF patients, with higher totals indicating greater likelihood of MMSE-2–defined cognitive impairment. The model demonstrated excellent discriminative ability, with an area under the curve (AUC) of 0.84. A cutoff ≥2 points identified cognitive impairment with 75% sensitivity and 83% specificity.
Conclusions
Cognitive impairment is a prevalent and clinically significant comorbidity in elderly HFpEF patients. The proposed point-based score is a simple, practical, and effective tool for identifying individuals at higher cognitive risk. Integrating cognitive screening into standard heart failure care may enable earlier intervention through vascular risk control, medication review, and cognitive support strategies, ultimately improving both cardiovascular and neurocognitive outcomes in this vulnerable population.Predictors of Cognitive ImpairmentFor image description, please refer to the figure legend and surrounding text.Cognitive Risk Score in HFpEFFor image description, please refer to the figure legend and surrounding text.