Factors associated with poor prognosis in elderly patients with congestive heart failure with comorbid cognitive impairment: impact of life circumstances

A ccording to the Japanese Ministry of Health, Labour, and Welfare, 14.2% of people were aged > 75 years in Japan in 2018, and this number continues to rise.With population aging, the incidence of congestive heart failure (CHF) is also increasing. [1][2]3] Reports have shown that the presence of cognitive impairment (CI) in patients with CHF is associated with poor prognosis, [4][5][6] and the degree of CI is related to CHF severity. [7]In Japan, the number of older adults with CI was estimated to be 4.62 million in 2012 and is predicted to reach approximately 7 million by 2025, resulting in 20% of whole population aged > 65 years.An epidemiological report suggested that the mortality risk of patients with CI is approximately 1.7-times that of patients without cognitive symptoms. [8]Therefore, the presence of comorbid CI in elderly patients with CHF may result in higher mortality than in patients with CHF without CI.The CHF with CI tends to coexist with left ventricular dysfunction, [9,10] atrial fibrillation, [11] and cerebrovascular disease, [12] negatively influencing prognosis.However, the exact factors that influence the prognosis of patients with CHF with comorbid CI have not been elucidated.In this study, we aim to identify the prognostic factors in patients with CHF with CI, focusing on both patients' life circumstances and conventional prognostic factors.This single-center prospective cohort study included consecutive elderly patients who were hospitalized for CHF at South Miyagi Medical Center, Shibata, Miyagi, Japan, from April 2019 to March 2020.This study was approved by the Institutional Review Board of South Miyagi Medical Center and was conducted in accordance with the Declaration of Helsinki.All patients provided written informed consent prior to enrollment.