Risk factors for adverse clinical outcomes in elderly patients with heart failure and cognitive frailty

Cognitive frailty, defined as the coexistence of frailty and cognitive impairment, poses a dual burden in elderly heart failure (HF) patients. Its impact on clinical outcomes, particularly hospitalization duration, rehospitalization, and survival, remains unclear. This study examines the relationship between frailty, cognitive impairment, and cognitive frailty with adverse clinical outcomes over 12 months.

A prospective cohort study included 250 elderly HF patients (mean age 72.32 ± 6.73 years), categorized into four groups: non-frailty/non-cognitive impairment (non-CI), frailty/non-CI, non-frailty/CI, and cognitive frailty. Baseline assessments included clinical, laboratory, and psychological evaluations. Outcomes measured were hospitalization length (>6 days), rehospitalization, and survival. Patients with cognitive frailty had significantly longer hospital stays (p < 0.0001). Elevated NT-proBNP levels were the sole predictor of prolonged hospitalization in this group (HR: 0.99, p = 0.048). In frail patients without CI, NT-proBNP was also a predictor (HR: 0.99, p = 0.004), along with lower BMI (HR: 0.88, p < 0.001), higher creatinine (HR: 3.42, p = 0.042), lower haemoglobin (HR: 1.41, p = 0.008), and anxiety levels (HR: 0.031, p = 0.005). No significant differences in rehospitalization or survival rates were observed among groups.

Cognitive frailty was associated with prolonged hospitalization among older patients with heart failure. Early identification and comprehensive care planning may help guide management and support this high-risk group.