Predicting Cognitive Impairment in Elderly Patients with HFpEF: Development of a Simple Clinical Risk Score

Background/Objectives: Cognitive impairment is a frequent and underrecognized comorbidity in elderly patients with heart failure with preserved ejection fraction (HFpEF), contributing to poor outcomes and complicating disease management. This study aimed to identify risk factors associated with cognitive impairment in elderly HFpEF patients from Western Romania and to develop a point-based risk score for clinical use. Methods: We conducted a cross-sectional analysis of HFpEF patients aged ≥65 years. Cognitive status was assessed using the Mini-Mental State Examination-2 (MMSE-2), with significant impairment defined as a score <24. Multivariable logistic regression analysis was performed to identify independent predictors of cognitive dysfunction. Results: A total of 326 HFpEF patients were 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) were independently associated with cognitive impairment. Higher Kansas City Cardiomyopathy Questionnaire (12-KCCQ) scores and anticoagulant therapy for atrial fibrillation were associated with a lower risk. Based on these variables, a simple point-based cognitive risk score was developed, demonstrating strong discriminatory ability (area under the curve = 0.84). A threshold of ≥2 points identified cognitive impairment with 75% sensitivity and 83% specificity. Conclusions: Our findings underscore the importance of integrated cardiovascular and cognitive assessment in elderly HFpEF patients. The developed risk score offers a pragmatic tool for the early identification of cognitive dysfunction, potentially informing timely interventions and preventive strategies.