Association of frontal assessment battery score with clinical outcomes in patients with heart failure and cognitive impairment

Cognitive impairment in patients with heart failure is associated with poor self-care and adverse outcomes. However, the association between Frontal Assessment Battery (FAB) performance and clinical outcomes in this population remains unclear. We investigated the association between FAB score and clinical outcomes in patients with heart failure and cognitive impairment. This was a single-centre retrospective cohort study. We screened consecutive patients hospitalised for heart failure between October 2022 and March 2025. Patients who underwent both MoCA-J and FAB assessments before discharge were considered for inclusion. The analysis was restricted to patients with cognitive impairment, defined as a MoCA-J score of 25 points or lower. The primary endpoint was a composite of all-cause mortality or readmission for heart failure. Among 140 patients with cognitive impairment (median age, 81 years; 54% men; median follow-up, 359 days), 85 were classified as High-FAB (≥ 12 points) and 55 as Low-FAB (≤ 11 points). The Low-FAB group had a significantly higher incidence of the composite outcome than the High-FAB group (log-rank P < 0.001), mainly driven by readmission for heart failure. After adjustment for age, sex, log-transformed NT-proBNP, and MoCA-J score, Low-FAB status remained associated with the composite outcome (hazard ratio, 1.915; 95% confidence interval, 1.078–3.402). In patients with heart failure and cognitive impairment, lower FAB performance was associated with a higher risk of adverse clinical outcomes, particularly readmission for heart failure. Larger prospective studies are needed to confirm these findings.